低位两孔法腹腔镜下腹膜透析置管术的临床研究

目的 比较低位两孔法腹腔镜下腹膜透析置管术与传统开腹置管术的疗效及安全性。方法 选取2016年6月～2019年12月于浙江大学医学院附属第一医院肾脏病中心接受首次腹膜透析置管术并治疗的终末期肾病患者639例,分为低位两孔法腹腔镜下置管组(A组,n=147)及开腹组(B组,n=492),回顾性分析2组患者手术前一般情况、围手术期情况、手术后并发症及转归情况。结果 A组的手术时间(t=-21.543,P<0.001)、住院时间(t=-2.398,P=0.017)较B组短,2组在手术中出血量(t=-0.011, P=0.991)、手术后疼痛(t=-1.650,P=0.100)、手术后腹膜透析开始时间(t=-0.211,P=0.833)、住院费用(t=-1.739,P=0.083)等比较无统计学差异;A组的漂管率(χ²=7.516,P=0.006)、血性腹膜透析液4.675,P=0.031)发生率低于B组,2组在堵管(χ²=0.762,P=0.383)、大网膜包裹(χ²=0.010,P=0.921)、腹膜透析液渗漏(χ     

腹膜透析置管技术的最新研究进展

腹膜透析(peritoneal dialysis, PD)是治疗终末期肾脏病患者的主要方法之一。PD置管是患者维持透析的生命通路。PD能顺利、有效的进行很大程度上依赖良好的PD置管术。近年来,国内外在PD置管技术上不断创新改进,积累了大量的经验。本文阐述了各种PD置管术最新改进改良方法。     

老年心力衰竭患者腹腔镜下腹膜透析置管术1例及文献复习

1 病例资料患者,男,63岁,因维持性血液透析滤过(HDF)治疗4年,夜间阵发性呼吸困难半年入院.患者于4年前开始HDF治疗,2周3次,血压130/80 mmHg左右,未服降压药,每日尿量1000 mL左右.半年前出现每次HDF治疗中血压升至≥180/110 mmHg,予非洛地平、硝苯地平控释片、卡维地洛、美托洛尔及缬沙坦等长期服用及HDF治疗中加用硝苯地平、卡托普利、硝酸甘油等,仍血压不降,无法坚持4h的HDF,只有增加HDF次数至每周3次,HDF间期血压维持在130～140/80 ～ 90 mmHg,逐渐出现夜间阵发性呼吸困难,需高枕甚至端坐入睡,日常活动气促、心悸.残余尿量逐渐减至每日100 mL左右.     

腹膜透析置管术的新进展

腹膜透析管路是腹膜透析治疗的基础,合理选择腹膜透析管,规范进行腹膜透析置管操作是保障其功能正常的关键。目前研究表明,各种腹膜透析管在合并症和生存率方面没有显著性差异,但需要注意卷曲状腹膜透析管可能增加透析管移位的风险。腹膜透析置管方式包括开放式手术置管、经皮穿刺置管和腹腔镜置管。各种方式各有优势,需要根据患者的状况和医生的技术进行选择。超声检查和放射介入技术在腹膜透析置管中可以发挥辅助作用,以保障成功率和安全性。先进的腹腔镜腹膜透析置管可以用于腹腔内存在复杂并发症的患者。可靠的腹膜透析置管技术和合理的腹膜透析处方,有助于减少紧急启动腹膜透析中透析液渗漏的发生。     

心理干预对腹膜透析置管术后病人疼痛的影响

[目的]探讨心理干预对腹膜透析置管术后病人疼痛的影响。[方法]将102例行腹膜透析置管术的病人随机分为对照组和观察组,每组51例,观察组在术后接受心理干预,对照组采用常规处理方法,不接受心理干预,对两组病人术后6h疼痛程度进行比较。[结果]观察组腹膜透析置管术后6h疼痛程度明显低于对照组(P0.01)。[结论]采用心理干预能有效降低腹膜透析置管术后病人的疼痛程度。     

清醒镇静麻醉用于腹膜透析置管术的有效性及安全性的临床研究

目的 探讨清醒镇静(conscious sedation,CS)麻醉在腹膜透析(peritoneal dialysis,PD)置管术中的有效性和安全性.方法 选取2017年1月～2020年5月在北京大学国际医院使用手术切开法行腹膜透析置管术的患者,根据麻醉方式不同分成2组:传统组(A组):术前30min肌肉注射盐酸哌替...     

腹膜透析置管术中X线辅助导管定位对相关并发症的影响

目的 探讨腹膜透析置管术中X线辅助导管定位对减少腹膜透析相关并发症的有效性.方法 2009年4月1日～2012年6月30日在江西省人民医院肾内科住院的终末期肾脏病（慢性肾脏病5期）腹膜透析置管患者124例,随机分为置管组（A组）与X线辅助导管定位组（B组）各62例,2组男/女比例分别为35/27例比40/22例,平均年龄（岁）37.5±10.2比39.6±11.8;A组采用传统开腹腹膜透析置管术,B组步骤同A组,但在收紧荷包前用小C臂机行盆腔X线检查,见导管腹内端位于真骨盆内.比较2组术后腹腔出血、管周渗漏和1月及1年内导管移位、网膜包裹、腹膜炎等并发症发生率差异.结果 A、B2组患者术后的腹腔出血发生率分别为3.2％、6.5％ （P=0.3994）;2组均无渗漏;A、B两组1月内导管移位率分别为6.4％、0,有显著统计学差异（P=0.0421）,1月内网膜包裹（0比1.6％,P=0.3154）及腹膜炎（1.6％比0,P=0.3154）的发生率,2组无明显差异;1年内导管移位（3.2％比1.6％ P=0.5587）、网膜包裹（0比0）及腹膜炎（1.6％比1.6％）的发生率2组无明显差异;患者术后1年内发生腹腔出血、渗漏、导管移位、腹膜炎及网膜包裹等总的并发症发生率A组较B组高,分别为16.1％、11.3％,但2组无显著统计学差异（P=0.4237）.结论 腹膜透析置管术中X线辅助导管定位可显著减少近期（1月内）导管移位的发生,降低1年内腹膜透析置管术总的相关并发症,值得临床推广.     

应用扇形拨开器与常规置管术在腹膜透析置管中的效果比较

目的 比较应用扇形拨开器的腹膜透析(peritoneal dialysis,PD)置管术与常规PD置管术术后引起的并发症,探讨应用扇形拨开器的PD置管术的临床效果. 方法 随机入选三峡大学人民医院肾内科2009年2月至2012年4月首次PD置管并接受PD治疗且观察满6个月的终末期肾病(end stage renal disease,ESRD)患者共69例,随机分为用扇形拨开器引导组(A组),常规手术组(B组),A组35例,B组34例,纪录2组术前的基本情况、术后感染并发症；同时观察比较2组术后6个月内的PD管移位率、导管阻塞率、渗漏、疼痛等机械并发症发生情况. 结果 2组患者的年龄、原发病情况无差别(P＞0.05)；A组患者导管移位3例(8.57％),B组患者导管移位10例(29.41％),两组相比有显著性差异(x2=4.899,P=0.027);A组患者重新置管2例(5.71％),B组患者重新置管8例(23.53％),2组相比有显著性差异(x2=4.417,P0.036);2组患者发生导管阻塞、渗漏、疼痛等并发症差异均无统计学意义(P＞0.05).2组患者发生感染并发症无统计学差异(P＞0.05). 结论 应用扇形拨开器的PD置管术可降低置管术后PD导管移位率,需重新置管率低.不增加PD置管术后感染率及机械并发症.     

不同腹膜透析模式治疗慢性肾衰竭的临床观察

目的 观察不同腹膜透析模式治疗慢性肾衰竭(CRF)的临床疗效.方法 选取2019年1月～2020年5月我院收治的95例CRF患者,依据随机数字表法分为CAPD组47例和DAPD组48例,CAPD组采用持续非卧床腹膜透析(CAPD)治疗,DAPD组采用日间非卧床腹膜透析(DAPD)治疗.观察两组患者透析前后实验室指标、肾...     

Bleeding complications associated with peritoneal dialysis catheter insertion.

OBJECTIVE: To identify the incidence of bleeding complications associated with peritoneal dialysis catheter insertion. DESIGN: Retrospective review at a tertiary-care center of all double-cuffed Tenckhoff catheters placed surgically from 1 January 1992 to 1 October 2003 to identify the incidence of major bleeding complications occurring with catheter insertion. Major bleeding episodes were defined as > or = 3% decline in hematocrit, or the need for surgical intervention or blood transfusion within 2 weeks of insertion. RESULTS: 292 catheters had been inserted in 263 patients. Six patients satisfied the criteria for a major bleeding event, for a major bleeding complication rate of 2%. Bleeding was associated with perioperative anticoagulation in 3 patients, uremia and thrombocytopenia in 1 patient, aspirin use and thrombocytopenia in 1 patient, and 1 patient experienced intraoperative bleeding. Coagulation parameters were not obtained prior to the procedure in 2 of the 6 patients. CONCLUSION: The rate of serious bleeding complications related to catheter insertion is low and usually associated with anticoagulation. Holding anticoagulation therapy for a minimum of 24 hours during the postoperative period should eliminate much of the risk. Coagulation parameters should also be obtained and corrected preoperatively.     

腹膜透析导管类型、导管置入位置选择及其相关研究

腹膜透析是治疗终末期肾病的一种成功方法，而建立持久、安全的透析通路又是慢性腹膜透析成功的关键。多年来，尽管腹膜透析导管的技术存活在不断提高，但是导管相关并发症仍时常导致腹膜透析技术性失败。针对此问题，国际腹膜透析学会（International Society for Peritoneal Dialysis，ISPD）专家组于1998年发布了关于理想腹膜透析通路的指南，并于2005年对指南进行了更新。2005年指南中有一重要结论，即不同透析中心之间导管结局存在确实的差异，这种差异与术和中心的特点较导管的设计更为相关。我们在临床实践中也发现同样类型导管并发症的发生率可因不同置管或透析中心而不同。因此，合理选用导管及掌握不同类型导管的插入技术是置管成功的关键。[第一段]     

Randomized prospective comparison of laparoscopic and open peritoneal dialysis catheter insertion.

OBJECTIVE: To compare laparoscopic and conventional peritoneal dialysis catheter insertion with respect to post operative discomfort, complication rates, and catheter survival. DESIGN: Randomized prospective study. SETTING: Tertiary referral renal unit. PATIENTS: Fifty patients commencing peritoneal dialysis. INTERVENTION: Catheters were implanted laparoscopically or by a conventional surgical technique. MAIN OUTCOME MEASURES: The duration of surgery, hospital stay, pain scores, and analgesic requirements were recorded. Complications (early/late) and catheter survival were compared. RESULTS: The conventional procedure was faster than the laparoscopic (14.3 vs 21.9 minutes, p < 0.0001). There was no difference in any other parameter assessed. CONCLUSIONS: The data suggest that the insertion techniques are equivalent, and that laparoscopic insertion does not reduce early complication rates.     

Absence of leakage by insertion of peritoneal dialysis catheter through the rectus muscle

To reduce leakage of peritoneal dialysis fluid, insertion of a 2-cuff Tenckhoff catheter (TeC) was performed under local anaesthesia by a lateral approach on 30 occasions in 26 patients. Incision was 3 cm laterally of the linea alba. The inner cuff of the TeC was fixed by a purse-string suture of the peritoneal membrane on the abdominal side of the cuff and another purse-string suture, of the inner fascial blade, around the distal end of the cuff. A third purse-string suture was placed around the TeC at the exit through the outer fascial blade. A subcutaneous tunnel completed the insertion. In all patients, dialysis was started immediately after TeC insertion. The median treatment time was 6.5 months (range 3 days-15 months). No leakage developed in any patient and no hernia was created from this approach. Peritonitis was treated on 8 occasions over a period of 163 months. We conclude that the technique is simple, enables immediate start of dialysis with low risk for leakage.     

应重视腹膜透析置管及其相关问题的临床研究

建立持久、安全的透析通路是慢性腹膜透析成功的关键。虽然腹膜透析植管技术简单，但导管相关并发症仍时常导致腹膜透析技术性失败的主要原因，在不同透析中心之间导管结局确实存在差异，这种差异与导管的选择、术技术水平、经验和中心的条件密切相关。某些导管相关并发症与最初的置管技术以及后期的管理不足相关。例如：导管移位、出口感染、腹膜炎等合理选用导管及掌握不同类型导管的插入技术是腹膜透析导管的成功置入，保证腹膜透析治疗顺利进行的关键。[第一段]     

Combined abdominal hernia repair and continuous ambulatory peritoneal dialysis (CAPD) catheter insertion

Out of a series of 290 surgically inserted continuous ambulatory peritoneal dialysis (CAPD) catheters, 19 patients had 24 abdominal hernias repaired at the same time as CAPD catheter insertion. All catheters were used immediately after our normal postoperative break in protocol. There were no fluid leaks from the hernia repair site but 3 catheters failed due to complications unrelated to the hernia repair. CAPD technique survival was not adversely affected in the hernia repair group.     

Repair of chronic peritoneal dialysis catheter.

BACKGROUND: Damage to the peritoneal dialysis catheter may be due to wear from long-term use, exposure to antibacterial agents (strong oxidants), and accidental injury from sharp objects. Repair of such catheter, if not associated with subsequent complications, would extend catheter life and reduce costs and patient inconvenience related to catheter replacement. OBJECTIVE AND DESIGN: Retrospective analysis of seven peritoneal catheters repaired 11 times over a 15-year period by splicing the old catheter with an extension tube using the Peri-Patch Repair Kit (Quinton Instrument Co., Bothwell, WA, U.S.A.). RESULTS: The life of these seven catheters was extended by a mean of 26 months (range 1-87 months), without increasing infection rates after splicing. The peritonitis rate after catheter splicing was 0.40 per year, not higher than the overall rate (0.76 per year) in our center during the same time period. Exit-site infections occurred in 6 patients after catheter splicing. Only one infection was related to trauma during the procedure and resulted in chronic exit infection; the catheter was eventually removed. In this patient, damage to the catheter was less than 1.5 cm from the exit site. CONCLUSIONS AND RECOMMENDATIONS: Splicing of the damaged peritoneal catheter, if properly done, is a safe procedure and can significantly prolong catheter life. We recommend that measures to prevent catheter damage, such as avoiding the use of scissors and other sharp objects, should be emphasized during the initial patient education and training. Alcohol and iodine should not be used on silicone rubber catheters. We suggest that the patient should report catheter damage immediately and come to the clinic within a few hours for catheter splicing (if possible) and prophylactic antibiotic to prevent peritonitis. Finally, we recommend that repair of the catheter should not be attempted if the breakage is less than 2 cm from the exit site, unless done as an emergency procedure if immediate catheter replacement cannot be performed.     

腹膜透析导管植入术患者围手术期的护理

探讨腹膜透析导管植入术患者围手术期的护理.选取本科收治的慢性肾功能不全尿毒症期患者23例,对其进行术前、术后护理及健康指导.23例植管成功、透析管路通畅者出院后行家庭腹透.1例4～5 d后出入液不畅,腹平片示腹透管移位,行体外复位后管路通畅.术前的心理疏导、术后的精心护理及健康教育是腹膜透析成功的重要保证.