中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (09): 732-736.doi: 10.3969/j.issn.1671-4091.2025.09.003

• 临床研究 • 上一篇    下一篇

腹膜透析患者改良型全身麻醉下单孔腹腔镜与局部麻醉开腹导管置管术临床疗效比较

纪丽琪   马直勉   李 军   王姣姣    隋满姝    王明奡   

  1. 150001 哈尔滨，哈尔滨医科大学附属第一医院1肾内科 3肿瘤腔镜外科
    150040 哈尔滨，2东北林业大学医院 综合内科
  • 收稿日期:2024-12-02 修回日期:2025-06-11 出版日期:2025-09-12 发布日期:2025-09-12
  • 通讯作者: 王明奡 E-mail:winnie_lxf@163.com
  • 基金资助:
    北京医卫健康公益基金会(BQ-24006)

Comparison of the clinical outcomes of single-port laparoscopic versus open peritoneal dialysis catheter placement

 JI Li-qi, MA Zhi-mian, LI Jun, WANG Jiao-jiao, SUI Man-shu, WANG Ming-ao   

  1. Department of Nephrology, 3Department of Tumor laparoscopic Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150000, China；2  Department of Internal medicine Northeast Forestry University Hospital, Harbin 150040, China
  • Received:2024-12-02 Revised:2025-06-11 Online:2025-09-12 Published:2025-09-12
  • Contact: 150001 哈尔滨，哈尔滨医科大学附属第一医院 肾内科 E-mail:winnie_lxf@163.com

摘要： 目的 腹腔镜置管具有直接探查腹腔情况和纠正导管位置等优势，但术中在腹壁打2或3孔的传统方法会增加腹壁疝及透析液渗漏等并发症的发生风险。本研究设计了一种简化的单孔腹腔镜置管术(single-port laparoscopic catheterization，SLC)。 方法 选取2023年3月─2023年9月在哈尔滨医科大学附属第一医院肾内科接受腹膜透析置管术的终末期肾病患者30例，分为SLC组(n=15)和开腹手术置管(open surgical catheterization，OSC)组(n=15)。比较2组患者术前基线资料、围手术期情况、手术后并发症及长期导管预后。 结果 所有患者均成功置入腹膜透析导管，手术中状态良好。与OSC组相比，SLC组手术时间短(t=-4.227，P＜0.001)、手术后住院时间短(Z=-3.124，P=0.001)、切口小(Z=-4.864，P＜0.001)、手术后疼痛较轻(t=-3.786，P=0.001)，但住院费用高(t=2.662，P=0.018)。至随访结束时，SLC组出现3例血性腹膜透析液，OSC组有5例出现血性腹膜透析液，1例早期腹膜炎伴导管移位，1例透析液渗漏，1例导管堵塞。1年导管生存率SLC组为93.3%，OSC组为86.7%。 结论 单孔腹腔镜下腹膜透析置管术是可行且安全的。

关键词: 腹膜透析, 单孔, 腹腔镜, 腹膜透析置管术

Abstract: Objective  Laparoscopic catheterization has the advantages of directly exploring the abdominal cavity and correcting the catheter position. However, conventional techniques typically require 2-3 ports, which may increase the risk of complications such as abdominal wall hernia and dialysate leakage. To address this, we designed a simplified single-port laparoscopic catheterization (SLC) technique.  Methods  30 patients with end-stage renal disease who underwent peritoneal dialysis catheterization at the Department of Nephrology, the First Affiliated Hospital of Harbin Medical University from March 2023 to September 2023 were selected and divided into a SLC group (n=15) and an open surgical catheterization (OSC) group (n=15). The baseline data before surgery, perioperative conditions, postoperative complications, and long-term catheter prognosis of the two groups were compared.  Results  No statistical differences in the baseline data between the two groups of patients. All patients underwent successfully peritoneal dialysis catheters inserted, with good intraoperative status. Compared with the OSC group, the SLC group had a shorter operation time (t=-4.227, P＜0.001) and postoperative hospital stays (Z=-3.124, P=0.001), smaller incisions (Z=-4.864, P＜0.001), and less postoperative pain (t=-3.786, P=0.001), but higher hospitalization costs (t=2.662, P=0.018). By the end of follow-up, 5 cases in the OSC group had bloody peritoneal dialysis fluid, 1 case had early peritonitis with catheter displacement, 1 case had dialysate leakage, and 1 case had catheter blockage, while the SLC group only had 3 cases of bloody peritoneal dialysis fluid, and no other catheter-related complications or infections occurred. The 1-year catheter survival rates for the two groups were 93.3% for the SLC group and 86.7% for the OSC group, respectively.  Conclusion   Single-port laparoscopic peritoneal dialysis catheterization is a feasible and safe technique with advantages including reduced operative time, shorter hospital stays, and fewer complications compared to open surgery.

Key words: Peritoneal dialysis, Single port, Laparoscopic, Peritoneal dialysis catheterization

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