腹腔镜在腹膜透析管复位中的临床应用

目的：评价应用腹腔镜手术方法行腹膜透析管复位的治疗效果,并总结相关治疗经验。方法收集2010年3月至2014年5月我院腹透中心收治的33例经常规保守治疗后,腹透液进出仍然不通畅,并确诊为导管持续性移位,须行手术复位腹膜透析导管患者的临床资料,进行回顾性分析,评价腹腔镜下腹透导管复位术的效果。结果33例导管持续性移位的患者均采用全麻下腹腔镜手术复位。术中所见多为单纯导管移位（21/33,63.6%）,腹腔镜直视下将腹膜透析管直接放至膀胱直肠陷窝或子宫直肠陷窝,并加用不可吸收线将导管固定于邻近腹壁,以减少再次移位的可能性；其次为大网膜包裹（12/33,36.4%）,腹腔镜直视下钝性分离包裹于导管上的大网膜,后续操作步骤同单纯导管移位者。全部33例患者均用上述技术成功复位,手术时间维持在30~45 min,平均出血量约5~10 ml；术中患者生命体征平稳,未见明显并发症；术后行腹膜透析,伤口处无渗液、漏液,伤口愈合良好；术后随访3~50个月,33例患者均可正常进行腹膜透析,未再出现导管移位。结论腹腔镜下腹膜透析管复位定位准确,切口小,易于愈合,合理运用可显著提高腹膜透析技术成功率。

Clinical application of laparoscope in resetting peritoneal dialysis catheter

Objective To evaluate the result of laparoscopic surgery in resetting peritoneal dial-ysis catheter （PDC）and summarize relevant experience during this experiment.Methods From March 2010 to May 2014,we choose 33 cases whose catheter was obstructed,and after conventional conser-vative treatment,dialysis fluid was still not unobstructed.They were diagnosed as persistent catheter displacement and the surgical reset was needed.The peritoneal dialysis clinical data were retrospec-tively analyzed,and the efficiency of laparoscopic surgery during peritoneal catheter reattachment was evaluated.Results All patients were under general anesthesia and catheters were reset by laparoscopic surgery.Intraoperative findings were mostly simple catheter malposition （21/33,63.6%）.These peritoneal dialysis catheters were directly placed in vesicorectal pouch or Douglas pouch and settled in the abdominal wall with silk thread,in order to reduce the likelihood of re-shifting.Following omen-tum majus pack （12/33,36.4%）,blunt dissection technique was used to isolate the omentum majus under laparoscopic direct vision.The subsequent steps were the same as before.The catheters in all 33 patients were successfully reset using the above techniques.Operative time was 30-45 min,average blood loss was 5-1 0 mL,patient vital signs were stable during surgery,and no significant complica-tions occurred.There was no leakage when postoperative peritoneal dialysis was taken.During a fol-low-up period of 3 to 50 months,no catheter displacement occurred in all patients.Conclusions The technique of laparoscopic surgery has accurate positioning,small incision and well healing in resetting PDC,and the technical success rate of peritoneal dialysis can be improved with proper assistance.