关键词: 腹膜透析, 腹膜透析管, 腹腔镜

Abstract:

Objective To evaluate a laparoscopic technique for insertion of peritoneal catheters in continuous ambulatory peritoneal dialysis (CAPD) patients with the history of lower abdominal surgery or/and peritonitis. Methods Between November 2002,and March,2005, the technique was applied in 8 patients (mean age 57.4 years, range 43.6 - 72 years) with end-stage renal disease. During laparoscopic surgery, a 5-mm trocar was placed just below the umbilicus for direct vision and a carbon dioxide pneumoperitoneum was induced up to 14 mmHg. A 5-mm trocar was placed in the standard lower paramedian position on the left side for operation. If there were no adhesion and the Douglas pouch was exposure well, the catheter was advanced into the abdomen under direct vision and guided toward the Douglas pouch through the operation port. If there was adhesion, then another 5-mm trocar was placed in the right lower quadrant and the dissector was placed into the abdominal cavity through this port. With the help of a forceps, the peritoneal catheter. was inserted into the Douglas pouch. The subcutaneous tunnel and the patency test of the catheter was performed as the last main steps in our procedure. Results All procedures were completed laparoscopically. The mean operative time was 30 minutes. There was no intraoperative complication or surgical mortality. One patient developed infection at the catheter exit site 7 days after surgery and was corrected 8 days later. During a mean follow-up time of 11.6 months, all patients went well. Conclusion Laparoscopic technique is feasible, safe, and effective for peritoneal dialysis catheter placements than the traditional method in the patients with previous lower abdominal operation.

Key words: Peritoneal catheter, Laparoscopy