腹腔镜在腹膜透析管置入术中的临床应用

目的 总结腹腔镜外科技术在腹膜透析管置入方面的临床应用经验.方法 选择16例慢性肾功能衰竭患者,其中7例行腹膜透析管放置固定术,5例行腹膜透析管复位固定术,4例行腹膜透析管疏通固定术.结果 16例患者腹透管均放置成功,手术时间30～45 min,均成功进行了腹膜透析,术后随访未发现严重并发症.结论 腹腔镜引导下放置和复位移位的Tenckhoff卷曲腹透管具有创伤小、腹透管放置定位准确、恢复快等优点,值得推广应用.     

腹腔镜引导下腹膜透析管移位复位术(附3例报告)

目的 总结腹腔镜外科技术应用在腹膜透析管移位复位方面的经验。方法 选择3例慢性肾功能衰竭腹膜透析导管移位患者，在腹腔镜引导下将移位的Tenckhoff卷曲腹透管或鹅颈式腹透管末端重新置入膀胱直肠窝或子宫直肠窝。结果 3例患者腹膜透析管均成功复位，手术时间约30min，均成功进行了腹膜透析，患者术后1周内出院。结论 腹腔镜引导下复位移位的腹膜透析管具有创伤小、无需重新手术切开复位，腹膜透析管放置定位准确，值得推广应用。     

腹腔镜腹膜透析管置入术在慢性肾衰竭合并腹部手术后患者中的应用

目的研究既往有腹腔手术、腹膜炎等特殊情况的慢性肾功能不全患者安全有效的腹膜透析管置入方法。对象与方法对第二军医大学长海医院肾内科符合CKD5期诊断标准8例患者,均有下腹部手术史或腹膜炎病史。手术方法为经脐下切1cm的弧形切口,插入5mm圆锥套管针(Trocar),以此孔做为观察镜通道,初步了解腹腔内情况。如患者有脏器粘连等情况,则在右侧腹直肌旁、脐下2cm处插入另一5mmTrocar为辅助操作孔,用以插入切割器,分离粘连组织,使用无损伤抓钳在屏幕直视下置入腹膜透析管。如无粘连等情况,则直接经操作孔置入腹膜透析管。结果2例患者应用切割器分离粘连的组织,4例患者借助无损伤抓钳使腹膜透析管放入膀胱直肠窝或子宫直肠窝,4例患者直接经操作孔道丝引导置入腹膜透析管。腹膜透析液进出通畅,无明显并发症发生。结论腹腔镜下置管术能在直视下将导管放入膀胱直肠窝或子宫直肠窝,是为有过腹腔手术或腹膜炎的患者置入腹膜透析管的有效方法。     

改良腹腔镜引导下腹膜透析管置入术的疗效观察

目的:观察改良的双戳孔法腹腔镜引导下腹膜透析管置入联合腔内固定术的疗效.方法:慢性肾功能衰竭患者22例,经腹腔镜直视下将Tenckhoff腹膜透析管置入盆腔,并采用经皮穿刺套线针将其固定于前腹壁,最后建立皮下隧道.结果:所有腹膜透析管均成功置入,同时联合腔内固定可防范术后导管漂管,无感染、拔管等严重并发症发生.结论:改良的双戳孔法腹腔镜引导下腹膜透析管置入腔内固定术方法简便安全,定位精准,术后并发症少.     

腹腔镜下腹膜透析管置放术的临床应用

目的 研究腹腔镜下腹膜透析管的置放方法及优势。方法 在腹腔镜直视下将腹膜透析管置放于膀胱直肠凹或子宫直肠凹，总结分析腹腔镜方法较传统置放方法的优势。结果 通过临床运用认为，腹腔镜下透管置放术方法易行，安全可靠，较传统手术方法导管置放更准确到位，不易漂移，手术时间短，病人损伤小，痛苦少，恢复快。结论 腹腔镜下腹膜透析管置放术安全可靠，方便易行，有较好临床运用推广价值。     

腹腔镜在腹膜透析管堵管中的临床应用

目的总结腹腔镜外科技术在腹膜透析管堵管治疗方面的临床应用经验。方法选择2003～2006年该科5例腹膜透析导管堵管后行腹腔镜检的患者,在腹腔镜引导下复通堵塞的Tenckhoff腹透管并进行网膜修整术或网膜切除术,并将腹透管末端重新植入直肠膀胱窝或直肠子宫窝。结果5例患者腹膜透析管均重植成功,手术时间20～45min,均成功进行了腹膜透析,于术后1周内出院,经长期随访,其中4例腹膜透析液引流通畅。结论腹腔镜引导下复通堵塞的Tenckhoff腹膜透析管具有创伤小、直视下对腹腔情况了解清楚、腹膜透析管放置定位准确、能预防再次堵管等优点,值得推广应用。     

自制弹簧套管钩针在腹腔镜腹膜透析管置入内固定术中的应用

目的 评价应用自制弹簧套管钩针在腹腔镜腹膜透析管置入术中辅助行内固定术的疗效及并发症.方法 2003年9月至2010年8月该院应用自制弹簧套管钩针为263例慢性肾功能不全患者行腹腔镜下腹膜透析管置入术时辅助行内固定术.结果 手术过程顺利,手术时间12～28 min,手术创伤小,术后漂管率低(1/263),患者均恢复满意,可早期行腹膜透析.主要并发症有继发性腹膜炎、穿刺点局部皮下血肿及术后腹膜透析管漂移堵管等.治疗效果良好.结论 自制弹簧套管钩针在腹腔镜下透析管置入及内固定术中的应用安全有效.可以极大的简化手术操作,节约手术时间,减轻手术应激,值得临床推广应用.     

单孔腹腔镜技术在腹膜透析置管术的应用研究

目的 研究单孔腹腔镜技术用于腹膜透析置管术的可行性、安全性和疗效.方法 18例术前均无腹腔手术史的慢性肾衰竭患者,局部麻醉下采用经皮微创穿刺技术建立下腹部16 Fr腹腔通道,使用直径5mm腹腔镜进入腹腔内定位,通过一次性可剥鞘将Swan-neck腹膜透析管一端放置到膀胱直肠窝或子宫直肠窝,近端建立皮下隧道并经左下腹戳洞引出.结果 所有腹膜透析管均放置成功,平均手术时间26.5min(14～35 min),术中出血极少,术后2～4 d出院.平均随访10.6个月(6～18月),未见漂管、渗漏、堵管、出血及感染等并发症.结论 单孔腹腔镜技术是一种安全可行、定位精确的腹膜透析置管新方法.     

TAP与腹直肌鞘加腹膜阻滞在尿毒症腹膜透析管置入术中的应用研究

目的 研究腹横肌平面（Transversus abdominis plane,TAP）与腹直肌鞘加腹膜阻滞对尿毒症腹膜透析管置入术的应用价值。方法 选取收治的60例接受腹膜透析管置入术的尿毒症患者,采用随机数字表法分为联合组和常规组各30例。常规组给予常规局麻,研究组采用TAP阻滞联合腹直肌鞘加腹膜阻滞麻醉。对比两组各时间点[进入手术室时（T0）、手术切皮时（T1）、手术结束时（T2）]的心率、舒张压及疼痛程度（VAS）评分水平;对比两组追加舒芬太尼率和不良反应发生率。结果 常规组T1和T2心率和舒张压水平均显著高于T0(P<0.05);常规组T1和T2心率和舒张压均显著高于联合组（P<0.05）;两组VAS评分均显著高于T0(P<0.05);联合组T1和T2 VAS评分均显著低于常规组（P<0.05）;研究组追加舒芬太尼率及不良反应发生率均显著低于常规组（P<0.05）。结论 TAP联合腹直肌鞘加腹膜阻滞在尿毒症腹膜透析管置入术中的应用效果显著,可有效降低术中疼痛,且对患者心率和血压的影响较低。     

腹腔镜在腹膜透析导管功能障碍中的应用

终末期肾脏疾病(end-stage renal diseases,ESRD)的替代治疗方法为血液透析(hemodialysis,HD)和腹膜透析(peritoneal dialysis,PD),但是也有部分PD患者因为不同原因转为HD,在PD早期(1年内)转HD的主要原因是技术失败(堵管、漂管、渗液等,23.1%)。     

Pregnancy in end-stage renal disease patients and treatment with peritoneal dialysis: report of two cases.

Pregnancy in end-stage renal disease patients is infrequent and is associated with fetal loss, premature delivery, intrauterine growth restriction, and lack of control of or exacerbation of or onset of hypertension. Even after replacement of renal function, the prognosis for the patient and the fetus is poor. A point of controversy is the renal replacement therapy method. This report is based on two clinical cases of pregnancy in peritoneal dialysis patients that resulted in full-term delivery. Adequate metabolic and blood pressure control was achieved during pregnancy, the only mutual complication being the presence of polyhydramnios. However, both infants were healthy for their gestational age and without neonatal complications. We may conclude that peritoneal dialysis is an acceptable therapeutic option for pregnant patients and their fetuses.     

Peritoneoscopic placement of a Tenckhoff catheter for chronic peritoneal dialysis

The use of peritoneoscopic control in the placement of a Tenckhoff catheter for chronic peritoneal dialysis permits accurate positioning of the catheter. As a result, the risk of malfunction during change of dialysis fluid is considerably reduced, and prior abdominal surgery and adhesions no longer automatically represent contraindications. A special trocar permits the introduction of the catheter to be done more gently, causes less scarring, and does away with the lower Dacron cuff. This prevents the kinking of the catheter in the abdominal wall, and makes the change of dialysis fluid more convenient. In addition, the procedure takes less time to carry out, as does the removal of the catheter on termination of dialysis.     

Abdominal wall hernias in end-stage renal disease patients on peritoneal dialysis

OBJECTIVE: To describe our experience with hernioplasty in peritoneal dialysis patients and to identify possible risk factors for surgical complications. DESIGN: A 4-year retrospective chart review of data. SETTING: Peritoneal dialysis unit of a university hospital. Patients and METHODS: 58 hernias in 50 patients were included. Detailed surgical technique and complications were recorded. Possible risk factors included age, gender, weight, height, body mass index, previous surgery, diabetes, time on dialysis, emergency surgery, hospital stay, type of hernia, mesh use, blood hemoglobin, and serum urea, creatinine, and potassium. RESULTS: Complications occurred in 12 hernioplasties (4 wound infections, 2 peritonitis, 4 catheter dysfunction, and 5 re-operations). Recurrence rate was 12% without mesh use and 0% with mesh hernioplasty. Dialysis was re-instituted in 96% of cases within 3 days postoperatively. Identified risk factors for complications were diabetes, low weight, low height, small body mass index, and low serum creatinine. CONCLUSIONS: Mesh hernioplasty in peritoneal dialysis patients is advisable. Postoperative dialysis with low volume is feasible after surgery. Prospective studies will corroborate our risk factors for morbidity.     

血液透析联合腹膜透析治疗终末期肾病的临床体会

目的 比较血液透析联合腹膜透析与单纯血液透析治疗终末期肾病的疗效。方法 对采用血液透析联合腹膜透析方式与单纯血液透析治疗终末期肾病的患者各9例者进行对照分析，观察两组患者透析前后血液生化指标及透析后主要并发症。结果 采用联合透析后血液中白蛋白、甲状旁腺激素（iPTH）含量较单纯血液（HD组）透析后明显降低（P<0.05），而血红蛋白含量较HD组高（P<0.05）;所观察的各项并发症的出现机会在联合透析组也明显低于单纯血液透析。结论 具备血透和腹透两种通路的终末期肾病患者采用联合方式透析比单纯血液透析治疗更具优越性。     

经皮穿刺腹膜透析置管术的临床应用

目的 比较经皮穿刺腹膜透析置管术与手术切开直视下腹膜透析置管术的临床应用效果.方法 单中心回顾性研究.66例腹膜透析患者,其中36例采用手术切开直视下腹膜透析置管,30例患者采用经皮穿刺腹膜透析置管.比较2组患者置管过程、置管后1月内腹膜透析管相关合并症和腹膜透析相关感染的发生率.结果 经皮穿刺腹膜透析置管组患者的操作时间、手术切口长度、术后需要使用镇痛剂患者的比例明显低于手术切开直视下腹膜透析置管组（t =8.614,P=0.000）,2组患者术中均未出现明显出血和脏器损伤,2组患者置管后1月内腹膜透析管路相关合并症和感染相关合并症的发生率差异没有统计学意义（P＞0.05）.结论 经皮穿刺腹膜透析置管术易于肾脏内科医生掌握和应用,对患者的损伤较小,并可以控制合并症的发生.     

Sleep related respiratory disorders in end-stage renal disease patients on peritoneal dialysis.

STUDY OBJECTIVE: To assess the possible effects of peritoneal dialysis (PD) on sleep-related respiration, which might result from dialysate bulk load in the abdomen and/or alterations in metabolic control of respiration during sleep. DESIGN: Subjective and objective measures of sleep were prospectively compared on randomly assigned nights with PD fluid (2.0 L) and without PD fluid in the peritoneal cavity in 11 end-stage renal disease (ESRD) patients on PD. SETTING: Tertiary-referral university hospital. PATIENTS AND METHODS: Fifteen consecutive patients on peritoneal dialysis who complained of chronic sleep disturbance and requested sedative were selected. Four patients declined polysomnographic studies. Consequently, 11 ESRD patients (8 males and 3 females) with a mean age of 63 +/- 4 (SEM) years were studied. RESULTS: Eight of the 11 patients reported multiple types of sleep difficulties. Polysomnographic recordings revealed significant primarily obstructive sleep apnea in 6 of 11 patients on at least 1 of 2 nights. Arterial blood pH, paO2, and paCO2 did not differ between nights with and without PD fluid in the peritoneal cavity in the group as a whole. In the 6 patients with sleep apnea, PaO2 was significantly lower (p less than 0.05) during the night with (PaO2 = 78 +/- 7 mmHg) than during the night without PD fluid (PaO2 = 92 +/- 4 mmHg). In the apneic patients, the amount of dialysate drained in the morning was negatively correlated with the minimum arterial oxygen saturation during the night (r = -0.94; p less than 0.005). CONCLUSIONS: This study indicates a significant relationship between PD patients with chronic sleep disturbance and sleep apnea syndrome. These data suggest that apneic patients may be susceptible to complications of dialysate bulk effect on oxygen desaturation.     

Tyrosine and N-carbamoyl-tyrosine in end-stage renal disease during continuous ambulatory peritoneal dialysis.

Lower-than-normal tyrosine concentrations of unexplained pathogenesis in plasma and intracellular body water have been reported in patients with chronic renal failure. We found a derivative of tyrosine that is not measured by the usual methods of amino-acid analysis because its alpha-amino group is blocked and cannot react to form other derivatives. An in vivo covalent reaction with urea-derived cyanate forms alpha-amino-carbamoyl-tyrosine (N-C-Tyr) in patients with end-stage renal disease. A longitudinal study of patients with end-stage renal disease who were treated with continuous ambulatory peritoneal dialysis shows that plasma that is obtained within 4 hours of the morning meal contains 70.1 +/- 6 mumol/L of tyrosine (mean +/- SEM) and 77.2 +/- 12 mumol/L of N-C-Tyr (mean +/- SEM). Thus there is a molecule of N-C-Tyr for each molecule of tyrosine present. The carbamoylation index or ratio of N-C-Tyr to tyrosine, blood urea nitrogen, episodes of peritonitis, and changes in dialysis protocol were compared. A reduction in the number of peritoneal dialysis exchanges resulted in parallel increases in carbamoylation index and blood urea nitrogen. Altering dialysis by increasing the number of exchanges or adding supplemental hemodialysis resulted in a decrease in the carbamoylation index with a delayed decrease in blood urea nitrogen. We found a significant increase of N-C-Tyr (p = 0.005) and of the carbamoylation index (p = 0.004) during six episodes of peritonitis compared with 10 periods of no peritonitis in two patients who had multiple episodes of peritonitis.(ABSTRACT TRUNCATED AT 250 WORDS)