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Clinical comparison of peritoneal dialysis catheter placement under laparoscope and by conventional surgical methods
AO Xiang, ZHOU Qiao-ling, NIE Wan-nian, OU YANG Yan-lan.
2012, 11 (10):
544-548.
doi: 10.3969/j.issn.1671-4091.2012.09.00
【Abstract】 Objective To compare the early and late complications, operation time, hospitalization day, and expenses for surgery and hospitalization between the placement of peritoneal dialysis (PD) catheters under laparoscope and by conventional operation method in patients with chronic kidney disease grade 5 (CKD grade 5). Methods A total of 357 patients diagnosed as CKD grade 5 were assigned into laparoscopic operation group (group A, n=141) and conventional operation group (group B, n=216) based on patients’ decision. In group A, the placement of PD catheter was carried out under laparoscope, and the distal end of the PD catheter was fixed by non-absorbable sutures. In group B, this manipulation was performed by using the conventional surgery of Seldinger technique. The differences in hemoglobin, platelet and serum creatinine before and after operation, operation time, early and later complications including bleeding, leakage, pain, peritonitis and catheter displacement, hospitalized day, and expenses for surgery and hospitalization were compared between the two groups. Results Patients having past history of abdominal operation accounted for 27.7% in group A and 0.9% in group B (X2=59.977, P=0.000). Serum creatinine reduced after the operation in both group A (911.45±318.59 μmm/L vs. 875.42±316.34 μmm/L; t=-3.189, P=0.003) and group B (875.42±316.34 μmm/L vs. 816.25±270.12 μmm/L; t=2.007, P=0.049). The operation lasted 35.2±16.1 min in group A and 56.4±22.3 min in group B (t=6.224, P=0.014). The operation spent 5478.59±896.91 yuan in group A and 3446.26±1381.23 yuan in group B (t=7.675, p=0.000). Bleeding was found in 10.6% and 2.8% (t=9.521, P=0.002), pain in 0.7% and 11.1% (X2=14.174, P=0.000), catheter displacement within one month in 0% and 4.6% (X2=6.716, P=0.010), leakage within one month in 12.8% and 2.8% (X2=13.572, P=0.000), peritonitis within one month in 7.8% and 1.4% (X2=9.311, P=0.002) of the patients, respectively, in group A and group B. The incidences of leakage, catheter displacement within one year, peritonitis within one year and diarrhea, hospitalization day, hospitalization expense, and average hospitalization expense per day were indifferent between the two groups (P＞0.05). Conclusion PD improves renal function even performed after a short period of time. Placement of PD catheter under laparoscope is suitable for renal failure patients with abdominal operation history. It also has the advantages of shorter operation time, less pain and lower incidences of catheter displacement within one month than those from conventional surgical method. However, bleeding, leakage and peritonitis are frequently seen in placement of PD catheter under laparoscope.
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