中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (02): 96-99.doi: 10.3969/j.issn.1671-4091.2014.02.009

• 临床研究 • 上一篇    下一篇

联合垂直隧道的低位腹膜透析导管置入法构建及效果

孙琤,张苗,蒋春明   

  1. 南京大学医学院附属鼓楼医院肾脏内科
  • 收稿日期:2013-08-20 修回日期:2014-01-01 出版日期:2014-02-12 发布日期:2014-02-12
  • 通讯作者: 张苗 zmslp@medmail.com.cn E-mail:zmslp@medmail.com.cn

The Establishment and Effect of Combined Vertical Tunnel with Low-site Peritoeal Dialysis Catheter Placement

  • Received:2013-08-20 Revised:2014-01-01 Online:2014-02-12 Published:2014-02-12

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摘要： 目的 构建联合垂直隧道的低位腹膜透析（peritoneal dialysis，PD）导管置入法并观察其临床效果。方法 2008年6月至2012年6月行联合垂直隧道的低位PD导管置入术的48例患者（B组）与同期行传统PD导管置入术的41例患者（A组）进行对照研究。所有患者均使用Baxter 双涤纶套 Tenckhoff 直管。联合垂直隧道的低位PD导管置入法的主要特点是低位（耻骨联合中点向上7cm）、导管腹内段剪短[根据腹膜切口至膀胱直肠窝（男）或子宫直肠窝（女）的距离]以及增加垂直的皮下隧道。术中记录所有患者PD导管修剪距离及腹内段长度。观察记录所有患者随访1年内有无并发症发生。结果 B组测量的导管修剪距离为（3.7±0.9）cm，腹内段长度为（11.3±0.9）cm。两组患者术后出血、PD液渗漏、外涤纶套膨出外露、灌液或放液疼痛等发生率以及腹膜炎发生次数/病人月、隧道炎或出口感染发生次数/病人月等方面比较无统计学差异；B组导管功能障碍（导管移位、非导管移位性功能障碍）发生率显著低于A组，差异有统计学意义(P<0.05)。结论 联合垂直隧道的低位PD导管置入法可以显著地减少PD导管功能障碍尤其是导管移位的发生，具有潜在减少PD技术性失败的重要作用。

关键词: 腹膜透析, 置管, 导管功能障碍

Abstract: Objective To evaluate the effect of combined vertical tunnel with low-site peritoneal dialysis catheter placement on catheter-related malfunction. Methods During the period from June 2008 to June 2012,48 patients received the operation of combined vertical tunnel with low-site peritoneal dialysis catheter placement(Group B) and 41 patients received the traditional open surgery(Group A).The Group A surgery was characterized by a low incision site, a shortened intra-abdominal catheter segment and an additional vertical subcutaneous tunnel. The distance of the shortened intra-abdominal catheter segment was measured during the operation. All patients were followed up for 1 year after surgery. Catheter-related complications were analyzed. Results The distance of the shortened intra-abdominal catheter segment was (11.3±0.9)cm. Catheter malfunction was the most frequent mechanical complication, found in 8 patients (19.5%) in Group A. Only 2 episodes(4.2%) of catheter malfunction ? were found in Group B, representing a rate significantly?less than?those in Group A (P<0.05). There was no significant difference in the episodes of leakage, inflow or outflow pain, bleeding, outer cuff extrusion and infectious complications between the two groups (P>0.05). Conclusion The combined vertical tunnel with low-site peritoneal dialysis catheter placement can effectively prevent catheter malfunction and is a reliable method for the peritoneal dialysis patients.

Key words: Peritoneal dialysis, Catheter placement, Catheter malfunction