摘要
目的探讨腹腔镜下腹膜透析置管术治疗终末期肾脏疾病的临床疗效及安全性。方法行腹腔镜下腹膜透析置管术治疗的终末期肾病患者175例。首次置管130例,传统置管术后再次置管45例。记录患者术后疼痛评分,随访期间有无隧道感染、置管堵塞、置管移位、重新置管率等相关指标。结果 175例患者均在腹腔镜下顺利完成手术,无中转开腹患者。手术时间30~60分钟,平均45.6分钟;术后3~9天出院,平均4.5天。随访时间3~36个月,平均20.4个月。使用肝素水于术后第2天开始冲洗置管,于术后4~9天后开始透析。4例患者进行腹膜透析治疗时流出淡血性液体,均于术后5~7天消失。患者术后疼痛评分(2.13±0.73)分,术后发生切口感染4例,均经换药处理后痊愈出院。2例患者分别于术后4个月、6个月因隧道口感染行腹膜透析置管取出术,随访过程中未发现导管移位、导管阻塞等情况,临床效果良好。结论腹腔镜下腹膜透析置管术与传统开腹手术比较,切口感染发生率低,并发症少,疼痛轻,恢复快。
Objective To investigate the clinical efficacy and safety of laparoscopic peritoneal dialysis in the treatment of end-stage renal diseases.Methods The clinical data of 175 patients with end-stage renal disease treated by laparoscopic peritoneal dialysis catheter were analyzed retrospectively.There were 130 patients treated by catheter for the first time,45 patients were remedied again.Postoperative pain score and follow-up period were observed in patients whether there were tunnel infection,catheter block-age,catheter displacement,rate of re intubation and other related indicators.Results 175 patients were successfully completed laparoscopic minimally invasive surgery,no conversion to open surgery.Surgery time was 30-60 minutes,an average of 45.6 minutes;discharge time was 3-9 days after surgery,average 4.5days.Follow-up time ranged from 3 to 36 months with an average of 20.4 months.Heparin was used to flush the catheter in the second day,after 4-9 days starting dialysis.4 cases with mild bloody liquid after therapy were recorded in 5-7 days.Postoperative pain score was 2.13 ±0.73,incision 4 patients were oc-curred infectionin after operation,who were cured and discharged from our hospital after positive dressing change.2 cases were treated by peritoneal dialysis catheter removal because of tunnel infection after 4 months and 6 months,respectively.During the follow-up,no catheter displacement,catheter blockage and other conditions were found,clinical effect was good.Conclusion Compared with the traditional open surgery,laparoscopic peritoneal dialysis catheter has incision infection rate lower,fewer complications,less pain,recovery fast and many other advantages,which is worth to be promoted.
出处
《临床外科杂志》
2017年第1期58-60,共3页
Journal of Clinical Surgery
基金
新疆维吾尔自治区人民医院院内科研资助项目(20130320)
关键词
终末期肾病
腹腔镜
腹膜透析置管术
end-stage renal diseases
laparoscopic
abdominal membrane dialysis
