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。     

慢性肾衰竭患者腹腔镜引导下腹透置管术的临床研究

目的总结在腹腔镜引导下放置Tenckhoff卷曲腹膜透析管的经验。方法选择16例慢性肾衰患者,在腹腔镜引导下,将腹膜透析管放置腹腔膀胱(子宫)直肠窝,并经皮下隧道引出。结果16例患者腹膜透析管均放置成功。手术时间为30～45min,患者术后均成功进行腹膜透析,术后1周左右出院。结论腹腔镜引导下放置Tenckhoff卷曲腹膜透析管定位准确,无手术切口。和常规开腹技术相比,该方法有独到的优越性,值得推广应用。     

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。     

腹腔镜引导下腹透置管术的临床研究

目的：以往需行腹膜透析的肾功能衰竭患者置放腹膜透析管需做一腹部切口，定位不够准确。本文介绍在腹腔镜引导下放置腹膜透析管的经验。方法：选择12例慢性肾衰患者。在腹腔镜引导下，将Tenckhoff腹膜透析管放置腹腔膀胱(子宫)直肠窝，并经皮下隧道引出。结果：所有腹膜透析管均放置成功，手术时间10min～20min，患者术后即顺利进行腹膜透析，术后2～7d出院。结论：腹腔镜引导下放置腹膜透析管定位准确。无手术切口。和常规开腹技术相比，有独到的优越性。     

腹膜透析早期透析管移位的原因分析和对策

目的探讨腹膜透析早期透析管移位的原因，提出护理对策。方法调查分析2005—2008年18例腹膜透析患者透析管移位的原因。结果18例腹透管移位患者中，长期卧床15例，切口位于脐部右侧13例。其中7例行复腔镜下复位术，6例患者经腹腔镜下复位术后3d再次出现引流不畅，X线摄片示腹透管移位，经保守治疗后腹透管复位；11例患者经保守治疗7～10d后，X线摄片示腹透管复位良好。结论腹透管移位与活动与手术部位有关，预防的关键在于指导患者术后早期活动，发生移位后首选保守治疗。     

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.     

腹透导管漂移的原因分析和护理对策

腹透导管漂移的原因分析和护理对策 胡春华,黄佳颖,方炜,严豪,李正元 （上海交通大学医学院附属仁济医院,上海 200127） 摘要 〔目的〕：研究各型腹透导管（Tenckhoff直管和Tenckhoff曲管）及其它诱因对发生漂管的影响,找出相应的预防及护理措施,以减少腹透导管发生漂移的几率,从而减少腹透相关并发症的发生。 〔方法〕：通过对于上海交大医学院附属仁济医院东部肾内科腹透中心自2007年1月~2009年11月期间141例尿毒症患者在接受腹透置管术中所使用的各类导管（直管或曲管）进行随机分组,以卡方检验的方法统计各类导管发生漂管的几率,并对引起漂管的其它常见因素进行统计,如术前包括腹部手术史、腹部外伤史;术后如姿势不当、腹膜炎、便秘、腹泻史、腹壁疝、腹腔内病理性占位等在已发生的导管漂移中所占的比例以百分比的方式通过三线表进行归纳、整理、分析,最终得出结果。 〔结果〕：结果表明,自2007年1月~2009年11月期间于上海交大医学院附属仁济医院东部肾内科腹透中心接受腹透置管手术的141例病员中,共计发生腹透导管漂移3例,其中男性2例,女性1例;原发病中糖尿病肾病引起的为1例,梗阻性肾病引起的为1例,原因不明引起的为1例; 曲管组发生漂管为2例,直管组发生漂管为1例,并使用SPSS 13.0统计软件进行卡方检验得出：直管组和曲管组漂管率无统计学差异（2% vs 3%, p=0.683）,腹透导管漂移与导管的类型（直管或曲管）无直接联系,通过对引起漂管的各类因素分析表明,因腹部手术史、腹膜炎、腹泻史引起漂管所占比例均为33%,而姿势不当引起漂管所占比例为100%,是为引起导管漂移的最直接因素。 〔结论〕：腹透导管发生漂移与手术中所置导管的类型无直接关联,腹透置管术后因姿势不当引起的腹透导管漂移发生的几率最大,规范做好导管的各项护理及对病员的宣教在为预防导管漂移的措施中起着相当大的作用,它能有效预防并避免导管的移位及其它并发症的发生,从而提高腹透患者的透析质量。 〔关键词〕：腹膜透析;漂管;护理     

腹膜透析中Tenckhoff卷曲管和直管的应用比较

腹膜透析疗法是终末期肾病替代治疗的主要方法之一,它具有疗效肯定、操作简便、不依赖机器、更合乎生理等优点.自从1965年Tenckhoff等人研究成功Tenckhoff透析管以来,成功地解决了重复使用腹膜通路问题,但以往由于腹膜炎发生率高,制约了腹膜透析的发展.本研究通过比较成人用带双扣套的Tenckhoff卷曲管和直接管(简称卷曲管和直管)的使用寿命,以便于选择更适合于国人的腹膜透析管.     

腹膜透析中Tenckhoff卷曲管和直管的应用比较

腹膜透析疗法是终末期肾病替代治疗的主要方法之一,它具有疗效肯定、操作简便、不依赖机器、更合乎生理等优点.自从1965年Tenckhoff等人研究成功Tenckhoff透析管以来,成功地解决了重复使用腹膜通路问题,但以往由于腹膜炎发生率高,制约了腹膜透析的发展.本研究通过比较成人用带双扣套的Tenckhoff卷曲管和直接管(简称卷曲管作者简介夏智明(1965-),男,湖南安化人,副主任医师,主要从事肾脏病临床工作.……     

腹腔镜下腹膜透析置管术的疗效及安全性

目的 比较腹腔镜下与常规腹膜透析置管术的疗效和安全性.方法 回顾苏州大学附属第一医院肾内科2007年12月～2010年12月接受腹膜透析置管并且规律腹膜透析(PD)的终末期肾病(ESRD)患者共86例,根据手术方式分为全麻下腹腔镜组(A组)和局麻常规手术组(B组),A组41例,B组45例,记录手术前后两组的基本状况、并...     

异丙酚和七氟醚麻醉用于腹腔镜腹膜透析置管术患者苏醒质量研究

目的 探讨异丙酚和七氟醚麻醉对腹腔镜腹膜透析置管术患者麻醉后苏醒质量的影响.方法 选择择期行腹腔镜腹膜透析置管术的终末期肾病患者100例,随机分成两组:异丙酚组(n=50),给予芬太尼、阿曲库铵、异丙酚行麻醉诱导,异丙酚、瑞芬太尼维持麻醉;七氟醚组(n=50):给予芬太尼、阿曲库铵、七氟醚行麻醉诱导,七氟醚维持麻醉.观察围手术期患者的血液动力学状态,术后麻醉恢复时间,疼痛、呕吐评分.结果 两组患者在气管插管时,血压、心率均升高(P＜0.05),七氟醚组较异丙酚组升高较低(P＜0.05);七氟醚组麻醉后苏醒时间较异丙酚组快(P＜0.05),两组疼痛、呕吐评分差异无显著性(P＞0.05).结论 七氟醚用于腹腔镜腹膜透析置管术麻醉诱导和维持,具有血液动力学平稳,苏醒快速的优点.     

血脂代谢紊乱与腹膜透析置管大网膜包裹的关系

目的探讨血脂代谢紊乱和腹膜透析置管术后发生大网膜包裹的关系。方法选择中南大学湘雅医院肾内科收集腹膜透析置管术后发生大网膜包裹病例15例,以同期未发生大网膜包裹病例30例为对照,对比二组发生血脂代谢紊乱的差异。同时,以是否存在血脂代谢紊乱分组,对比腹膜透析置管术后大网膜包裹的发生率。结果大网膜包裹组的三酰甘油（TG）、胆固醇（CHO）和低密度脂蛋白（LDL）明显高于非大网膜包裹组;大网膜包裹组载脂蛋白A1（APOA1）水平则低于非大网膜包裹组。结论血脂代谢紊乱与腹膜透析置管术后发生大网膜包裹相关,可能是易于发生大网膜包裹的一个危险因素。     

A New Simplified One-Port Laparoscopic Technique for Peritoneal Dialysis Catheter Placement

♦ Background: Various techniques for laparoscopic insertion of a peritoneal dialysis catheter have been described. Usually 2 - 3 ports are required, and complications related to the port sites (such as abdominal wall hernia, leakage, and hemorrhage) cannot be avoided. To minimize the potential complications, we designed a simplified 1-port laparoscopic technique for peritoneal dialysis catheter placement.♦ Methods: We conducted a retrospective data review of 44 patients who underwent 1-port laparoscopic insertion of a Tenckhoff catheter from June 2009 to February 2011. All patient data, including postoperative complications, were analyzed.♦ Results: The mean follow-up period was 11.52 months. All catheters were working properly, except in 1 patient who developed peritonitis 3 months after catheter placement. (The catheter was removed.) No postoperative abdominal wall hemorrhage, early leaks, hernias, or catheter migration occurred. No exit-site or tunnel infections were observed.♦ Conclusions: Our 1-port laparoscopic technique provides excellent catheter fixation, avoids excessive port sites, and yields good cosmesis. The low complication rate and the simplicity of the method justify its standard use for Tenckhoff catheter placement.     

Management of refractory peritonitis to maintain the peritoneum for subsequent dialysis.

Peritonitis and its sequelae remain major clinical problems in treating peritoneal dialysis (PD) patients. One of these sequelae is the formation of intra-abdominal adhesions, preventing a patient from returning to peritoneal dialysis after a Tenckhoff catheter is removed for refractory peritonitis. We have recently applied a technique that appears to reduce the incidence of this severe complication. When it is determined that a catheter will be removed for refractory peritonitis, hourly peritoneal dialysis exchanges are performed for 12 hr prior to surgery. Postoperatively, the abdomen is rested for 48 hr, after which a temporary peritoneal dialysis catheter is placed at the bedside and hourly exchanges (with antibiotics) are performed for 2-3 days or until the dialysis fluid white blood cell count improves. Then the temporary catheter is removed and the abdomen is rested until the Tenckhoff catheter is replaced in 10-14 days. We treated 5 consecutive patients with refractory peritonitis (2 Pseudomonas, 1 Proteus, 1 Candida, 1 S. aureus) with this technique. All 5 patients were able to return successfully to peritoneal dialysis. At our institution over the past five years, 9 patients with refractory peritonitis due to the same organisms have had their catheters removed. Only 5 (56%) were able to return to PD. Although preliminary, our technique holds promise for those patients wishing to return to peritoneal dialysis after having a catheter removed for refractory peritonitis.     

腹膜透析患者腹腔镜胆囊切除术的临床观察

目的探讨腹膜透析患者腹腔镜胆囊切除术（LC）的安全性及可行性。方法回顾分析该院1999年6月～2005年12月9例腹膜透析患者因慢性胆囊炎、胆囊结石行LC的临床资料。结果全部患者成功施行LC，手术时间45～120min，术后当日开始恢复腹膜透析；术后住院5～7d，无严重并发症。结论腹膜透析患者LC安全可行；充分的围手术期准备和处理是成功的关键。     

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.     

Peritoneal catheters and exit-site practices toward optimum peritoneal access: a review of current developments.

OBJECTIVE: This review updates the 1998 International Society for Peritoneal Dialysis (ISPD) recommendations for peritoneal dialysis catheters and exit-site practices (Gokal R, et al. Peritoneal catheters and exit-site practices toward optimum peritonealaccess: 1998 update. Perit Dial Int 1998; 18:11-33.) DESIGN: DATA SOURCES: The Ovid and PubMed search engines were used to review the Medline databases of January 1980 through June 2003. Searches were restricted to human data; primary key word searches included dialysis, peritoneal dialysis, and continuous ambulatory peritoneal dialysis cross referenced with access, catheter, dialysis catheter, peritoneal dialysis catheter, and Tenckhoff catheter. Related searches were provided via the PubMed related articles link. Study Selection: Reports were selected if they provided identifiable information on catheter design, catheter placement technique, and survival or placement complications. Reports without such data were excluded from review. Each study was then categorized by its characteristics: single-center or multicenter; retrospective or prospective; controlled trial, with or without random patient assignment; or review article. MAIN RESULTS: There are few randomized controlled evaluations testing how catheter design and/or placement influence long-term survival and function, and these are typically conducted at a single center. The majority of reports represent retrospective single-center experiences, and these are supplemented by occasional multicenter data registries. CONCLUSIONS: There is substantial variability in catheter outcomes between centers, and this variability is more closely correlated with operator and center characteristics than with catheter design. Some catheter designs appear to impact long-term catheter success, and, in some cases, specific patient characteristics and dialysis formats combine with specific catheter designs to influence catheter survival. Most reporters prefer two-cuff designs and placement of the deep cuff at an intramuscular location. Intramuscular cuff placement results in fewer pericatheter leaks and hernias, but makes catheter removal more difficult. High-risk patients (those with previous pelvic surgery) benefit from visual inspection of the peritoneum during catheter placement, and in randomized controlled trials, catheters with pre-shaped arcuate subcutaneous segments ("swan neck" designs) reduce the risk of early drainage failure via "migration."     

Laparoscopic Intraperitonealization of Accidentally Misplaced Peritoneal Dialysis Catheter: A Salvage Procedure

Tenckhoff catheter placement is a well-established procedure to facilitate continuous ambulatory peritoneal dialysis (CAPD) in end-stage renal disease (ESRD) management. Catheter malposition is a possible cause of catheter malfunction. Options to deal with early malfunction are re-exploration, omentectomy, repositioning, or new catheter placement. Technical malpositioning can be dealt with early, with minimal morbidity and cost. Here we report a case of a CAPD catheter accidentally placed preperitoneally which was salvaged using videolaparscopy.     

Laparoscopic placement of Tenckhoff catheters for peritoneal dialysis: a safe, effective, and reproducible procedure.

BACKGROUND/AIMS: Currently there are several techniques for laparoscopic placement of peritoneal dialysis catheters. The aim of this paper is to describe our technique and outcomes. PATIENTS AND METHODS: Laparoscopic implantation of peritoneal catheters was performed in 100 consecutive patients. The technique employed laparoscopically guided musculofascial tunneling to maintain catheter orientation toward the deep pelvis, and adhesiolysis to eliminate compartmentalization that could affect completeness of dialysate drainage. Mean duration of surgery, hospital stay, morbidity, mortality, and catheter survival were assessed. Analysis of catheter survival was performed using the Kaplan-Meier method, with censoring of catheter loss due to death or successful transplantation. RESULTS: Mean operative time was 20 +/- 7 minutes and average duration of hospital stay was 3 +/- 1 days. There were no conversions from laparoscopy to conventional catheter insertion methods. No exit-site or tunnel infections, hemorrhagic complications, abdominal wall hernias, or catheter cuff extrusions were detected. No mortality occurred in this series of patients. Catheter survival was 97%, 95%, and 91% at 1, 2, and 3 years, respectively. CONCLUSIONS: The laparoscopic method described in this report is compliant with consensus guidelines for best-demonstrated practices in peritoneal access placement. Laparoscopy permits direct visualization of all procedure steps in a safe efficient reproducible manner. The laparoscopic approach afforded patients the advantage of short procedure times, a minimally invasive approach, and excellent outcomes. The results reported in this paper support our opinion that laparoscopic Tenckhoff catheter implantation should become the standard of care for clinical practice.