“三点一线”术式腹腔镜腹膜透析管置入术体会

目的总结"三点一线"术式腹腔镜腹膜透析管置入术的体会。方法 2012-08—2016-08间郑州大学第一附属医院腹腔镜外科对526例终末期肾脏病患者行腹腔镜腹膜透析管置入术,回顾性分析患者的临床资料。结果 526例均成功完成手术,手术时间35~92 min,平均58.80 min。术后腹膜透析时间3~12 d,平均6.70 d。住院时间7~16 d,平均8.52 d。近、远期并发症发生率为3.42%。结论充分的术前准备及规范有序的手术操作,可降低腹腔镜腹膜透析管置入术后并发症发生率,延长透析管使用时间,提高患者生存率。     

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。     

腹腔镜技术在处理腹膜透析管大网膜包裹中的应用

目的总结腹腔镜技术在腹膜透析管大网膜包裹复位方面的经验。方法选择3例慢性肾衰竭腹膜透析管引流不畅患者,通过腹腔镜将缠绕嵌腹膜透析管的大网膜钝性分离,末端重新置入膀胱直肠陷凹或子宫直肠陷凹;并将局部大网膜缝吊于上腹部。结果3例患者腹膜透析管均成功复位,手术时间15—30min,均成功进行了腹膜透析。结论腹腔镜引导下复位大网膜包裹的腹膜透析管创伤小、无需重新手术更换腹膜透析管,腹膜透析管放置定位准确,值得推广。     

腹膜透析管整复术的临床应用

随着腹膜透析技术的广泛临床应用 ,腹膜透析并发症亦日渐多见。腹透管的漂移、大网膜包裹粘连和纤维块及血凝块的堵塞是临床常见并发症 ,往往导致腹透液流入和 /或流出不畅而致腹膜透析失败。以往针对此类并发症采用非手术疗法多不能奏效而不得不采用手术重新植管 ,但是重新植管费用高、住院时间长、患者多不能接受。我科于1997年 5月～ 1999年 12月采用腹膜透析管整复术处理 10例患者取得了较好的效果。现报告如下。资料与方法1　一般资料　 10例病人均为慢性肾功能衰竭尿毒症患者 ,原发疾病为慢性肾小球肾炎 5例 ,糖尿病肾病 2例 ,多囊肾 …     

腹腔镜引导下腹膜透析置管术

腹膜透析(腹透)治疗常规需要行腹透插管手术,我们介绍在腹腔镜引导下放置腹透管的经验。 对象与方法 1.对象:自2000年11月以来,13例慢性肾功能衰竭患者在本科接受了视屏腹腔镜引导下的腹透管置放术。男性8例,女性5例,年龄21～70岁;慢性肾炎11例,慢性肾盂肾炎和肾小动脉硬化症各1例。     

单通道腹腔镜辅助下腹膜透析管置入术的临床应用

目的探讨单通道腹腔镜辅助下腹膜透析管置入术的临床应用可行性和疗效。方法 13例术前均无腹腔手术史的慢性肾衰患者,局麻下采用经皮微创穿刺技术建立下腹部16 F腹腔通道,使用直径5 mm腹腔镜进入腹腔内定位,通过一次性剥皮鞘将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刺口引出。结果所有腹膜透析管均放置成功,平均手术时间（28±8）min,术中出血少,术后3-7 d出院。最长者已随访12月,未见漂管、渗漏、堵管、出血、感染等并发症。结论单通道腹腔镜辅助下腹膜透析管置入术是一种定位精确、安全可靠、并发症少的置管新方法。     

腹腔镜疝修补术治疗腹膜透析后并发腹股沟疝

目的探讨腹腔镜疝修补术治疗腹膜透析后并发腹股沟疝的可行性。方法对26例慢性肾功能不全、长期接受腹膜透析后并发腹股沟疝行腹腔镜下疝修补术，术中对斜疝行腹腔镜下内环口缝扎并在腹腔内置入网片，对直疝行腹腔镜下疝囊高位悬吊后腹腔内置入网片。结果26例均获成功，无中转开放手术，术后无阴囊血肿、顽固性神经痛等。26例随访6-12个月，平均9个月，疝无复发。结论腹腔镜疝修补术治疗腹膜透析后腹股沟疝可行，有效，安全。     

腹腔镜下置入腹膜透析管术患者的护理

对24例尿毒症患者采用腹腔镜下置入腹膜透析管行腹膜透析.经完善的术前准备,术后重点进行伤口、饮食及透析管护理,透析方式的把握及灌注量的控制,24例均置管成功,住院(7.5±5.1)d,与常规置管方法比较,差异有显著性意义(P<0.01);且能顺利进行腹膜透析.     

Laparoscopic placement of peritoneal dialysis catheters in children

Background

Peritoneal dialysis (PD) is preferred over hemodialysis. The aim of this study was to evaluate our experience with laparoscopic PD catheter placement and omentectomy in children.

Methods

We reviewed all children (N = 21) who underwent laparoscopic placement of PD catheters and omentectomy. Ages ranged from 3 months to 16 years. Five children had previous major abdominal surgery and required extensive lysis of adhesions. During the same intervention, other surgical procedures were performed using laparoscopy or open technique, including umbilical hernia repair in 3, bilateral inguinal hernia repair in 3, ventral hernia repair in 2, gastrostomy in 4, kidney biopsy in 2, and cholecystectomy in 1.

Results

Thirteen children received successful kidney transplantation and no longer needed dialysis. Two children still have functioning PD catheters. One patient developed membrane failure and was converted to hemodialysis. Four patients recovered enough renal function and no longer need dialysis. There were no complications related to the laparoscopic procedure.

Conclusion

Laparoscopy is ideal for PD catheter placement. It facilitates omentectomy, and it allows for the catheter to be placed in the proper position under direct vision and for lysis of adhesions to increase peritoneal surface. Other abdominal procedures can be performed laparoscopically at the same time.     

Laparoscopic omental fixation technique versus open surgical placement of peritoneal dialysis catheters

Background: Continuous ambulatory peritoneal dialysis (CAPD) is an effective form of treatment for patients with end-stage renal disease. Open insertion of peritoneal dialysis (PD) catheters is the standard surgical technique, but it is associated with a relatively high incidence of catheter outflow obstruction and dialysis leak. Omental wrapping is the most common cause of mechanical problems. The purpose of this study was to determine the efficacy of the laparoscopic omental fixation technique to prevent the obstruction caused by omental wrapping and also to compare this laparoscopic technique with open peritoneal dialysis catheter insertion with respect to postoperative discomfort, complication rates, and catheter survival. Methods: Between March 1998 and October 2001, 42 double-cuff, curled-end CAPD catheters were placed in 42 patients. The outcomes of the 21 patients in whom the PD catheters were placed laparoscopically with omental fixation technique were compared with those of the 21 patients in whom the catheters were placed with open surgical technique. Recorded data included patient demographics, catheter implantation method, early and late complications, catheter survival, and catheter outcome. Results: Early peritonitis episodes occurred in 8 of 21 patients (38.0%) in the open surgical group (OSG) versus 2 of 21 patients (9.5%) in the laparoscopic omental fixation group (LOFG) (p < 0.05); late peritonitis episodes occurred in 3 of 21 patients (14.2%) in the OSG versus 1 of 21 patients (4.7%) in the LOFG (p < 0.05). Early exit site infection occurred in 8 of 21 patients (38.0%) in the OSG versus 4 of 21 patients (19.0%) in the LOFG (p < 0.05), with many catheter-related problems in the conventional surgical group. There was no outflow obstruction in the LOFG. The conventional procedure was faster than the laparoscopic omental fixation technique. Analgesic requirements and hospital stay were less in the laparoscopic group. Laparoscopic surgery also enabled diagnosis of intraabdominal pathologies and treatment of the accompanying surgical problems during the same operation. Occult inguinal hernia was diagnosed in 2 patients, inguinal hernioplasty was performed in 4 patients, adhesiolysis was performed in 8 patients who had previous abdominal surgery, and liver biopsy was taken in 2 patients. Ovarian cystectomy was performed in another patient during laparoscopic CAPD catheter placement. Conclusion: The laparoscopic omental fixation technique (described by Öünç and published in 1999) is a highly effective and successful method for preventing obstruction due to omental wrapping with a better catheter survival. Laparoscopic surgery also allows the diagnosis and treatment of the accompanying surgical pathologies during the same operation.     

Peritoneal dialysis for chronic renal failure in a patient with methylmalonic acidaemia

Chronic renal failure is a common complication of methylmalonic acidaemia (MMA). It is usually managed with haemodialysis and renal transplantation. We report the use of continuous cycling peritoneal dialysis (CCPD) for 20 months in a paediatric patient with chronic renal failure due to MMA. This procedure resulted in the elimination of 950 μmol methylmalonate (MM) per day and a fall in the plasma MM concentration from 3.9 to 0.74 mmol/l. As a result of this treatment, the frequency at which this patient was hospitalised was markedly reduced prior to a successful renal transplantation.     

Laparoscopic management of malfunctioning peritoneal dialysis catheters

BACKGROUND: Continuous ambulatory peritoneal dialysis (CAPD) is an established alternative method to hemodialysis for treating end-stage renal disease patients. However, this method is associated with a significant number of complications, such as catheter malposition, omental wrapping, and infection. The purpose of this study was to determine the efficacy of laparoscopy in the treatment of malfunctioning CAPD catheters. METHODS: Between November 1994 and June 1999, a total of 16 patients with CAPD underwent laparoscopy for the evaluation and management of CAPD catheter dysfunction. Two trocars (10-mm and 5-mm) were used. Recorded data included patient demographics, catheter implantation method, date of malfunction, cause of dysfunction, procedure performed, complications, and catheter outcome. RESULTS: The primary etiology of dysfunction was omentum and/or small bowel wrapping with adhesions in eight cases, malpositioning in five cases, and infection in the remaining three cases. Adhesiolysis was performed in the eight cases with adhesions. In the five cases with malpositioning but no adhesions, the catheters were repositioned in the pelvic cavity. Two catheters had to be withdrawn because of infection. In one case with tunnel infection, the catheters were exchanged simultaneously. There was only one perioperative complication, consisting of temporary dialysate leakage. There were no mechanical or infection problems. The overall success rate of catheter function (>30 days after laparoscopy) was 100%, except for two cases in which the catheters had to be removed. CONCLUSION: Laparoscopy is a highly effective and successful method for the evaluation and management of peritoneal dialysis catheter dysfunction.     

Comparison of open and laparoscopic secure placement of peritoneal dialysis catheters

Background A major and frustrating complication of peritoneal dialysis catheter placement is mechanical outflow obstruction, which may be caused by catheter tip migration. Therefore, a secure and correct positioning of the catheter is important to minimize this risk. This technique is easily accomplished by a laparoscopic approach.Methods The outcomes of 50 patients in whom peritoneal dialysis catheters were inserted laparoscopically with a secure catheter placement technique were compared with those of 52 patients who underwent an open surgical technique using a stiff wire as guidance for the catheter. The data were prospectively collected but not randomized. All the patients had virgin abdomens, and all the procedures were undertaken or supervised by one surgeon.Results Catheter migration occurred in six patients (12%) in the open group, as compared with none in the laparoscopic group (p = 0.027). There were no significant differences in catheter survival between the two groups.Conclusions The laparoscopic technique with secure placement of the catheter lowered the incidence of catheter migration, but did not increase the catheter survival.     

Laparoscopic management of Tenchkoff catheters in continuous ambulatory peritoneal dialysis

We describe a one-port laparoscopic technique for assisting in Tenchkoff catheter placement and salvaging obstructed ones in patients requiring continuous ambulatory peritoneal dialysis (CAPD). This unique technique enables diagnostic laparoscopy, adhesiolysis, repositioning of catheters, and omentectomy to be performed without laparotomy. Six patients were treated. Only one 10-mm port was required, using an operating laparoscope and an instrument introduced through the working channel of the laparoscope. Adhesiolysis was performed under laparoscopic vision; omentectomy and flushing of blocked catheters were carried out extracorporeally. The catheters were then repositioned to the pelvic cavity under laparoscopic vision. All patients were followed up for 6–10 months. No mechanical problem was noticed. Our one-port laparoscopic technique is a simple and effective method for treating patients who have mechanical problems with their peritoneal dialysis catheters. Received: 14 January 1997/Accepted: 14 April 1997     

慢性肾衰竭腹膜透析患者的预后分析

目的分析慢性肾衰竭腹膜透析患者的生存率及预后影响因素。方法回顾性调查2003年1月至2011年6月在我院规律随访的353例腹膜透析患者,总结患者的预后和退出原因,比较死亡患者与继续腹膜透析患者临床指标差异,分析患者死亡的危险因素和独立危险因素。结果353例患者中退出159例,其中死亡74例,死亡原因主要是心血管疾病。腹膜透析患者1年、2年、3年、4年的生存率分别为92％、80％、68％、58％。Logistic回归分析显示,年龄、糖尿病肾病、血红蛋白、血白蛋白和血肌酐是患者死亡的危险因素。COX回归分析显示,年龄、血红蛋白和血肌酐是死亡的独立危险因素（均P〈0．05）。结论根据年龄、血红蛋白和血肌酐水平可以对腹膜透析患者预后做初步判断,重视患者的营养状况,有利于改善预后、降低死亡率。     

Peritoneal dialysis catheters: laparoscopic versus traditional placement techniques and outcomes

BACKGROUND: Peritoneal dialysis is used for renal replacement therapy in over 25,000 patients in the United States. Some authors have recommended laparoscopic guidance for peritoneal dialysis catheter (PDC) placement, although consensus statements have not favored a specific technique. This study reviews outcomes in patients in whom placement was performed by the traditional "blind" technique (B-PDC) versus the laparoscopic technique (L-PDC). METHODS: Records were retrospectively reviewed of 25 consecutive PDC patients in each of 3 university-affiliated tertiary medical center hospitals. Data for PDCs placed by B-PDC (n = 30) or L-PDC (n = 45) technique were reviewed and the outcomes compared. RESULTS: L-PDCs offered 97.8% immediate functional success as opposed to 80% with B-PDC placement (P = .014). In addition, laparoscopic placement of peritoneal dialysis catheters had a lower incidence of PDC revision or replacement (P = .035). CONCLUSION: L-PDCs were found to have a higher immediate functional success rate than B-PDCs and a lower incidence of catheter revision or replacement.     

Laparoscopic-assisted peritoneal dialysis catheter placement: a microinvasive technique

Background Peritoneal dialysis is an alternate form of dialysis for patients with end-stage renal disease (ESRD). Although not as widely used as hemodialysis, peritoneal dialysis (PD) has clear advantages, especially those related to patient satisfaction and simplicity. The purpose of our study was to describe and look at the results of a microinvasive technique for placement of peritoneal dialysis catheters under laparoscopy. Methods From August 2003 to January 2006, 12 patients with ESRD underwent laparoscopic-assisted peritoneal dialysis (LAPD) catheter placement with the microinvasive technique at our institution. Data collected included age, gender, underlying renal disease, and length of operation. Followup was completed for all patients (at least 6 months) and catheter-related morbidity and mortality were also analyzed. Results There were 13 procedures performed (one patient had LAPD catheter placement twice). The average age was 45 years and the most common cause of ESRD was uncontrolled arterial hypertension. Procedural time averaged 33.6 min (range = 24–50 min). Peritoneal dialysis was introduced two weeks after the procedure and no dialysate leaks were observed. There were two catheter-related morbidities; both were catheter exit-site abscesses, one managed surgically with removal of the PD catheter and the other managed conservately with culture-sensitive antimicrobials. Patient satisfaction was beyond acceptable in 92% of the patients (12 of 13). Average longevity of the catheter was 61 weeks (427 days). There were no mortalities. Conclusion LAPD catheter placement is an easy technique with acceptable catheter longevity and minimal morbidity. The microinvasive technique leads to better patient satisfaction and cosmetic outcome without affecting its function. Therefore, we believe that by promoting microinvasive LAPD catheter placement, PD will gain more acceptance among doctors and patients.     

Continuous ambulatory peritoneal dialysis in patients with renal failure due to multiple myeloma

Continuous ambulatory peritoneal dialysis (CAPD) is being used only in limited number of patients with renal failure due to multiple myeloma, despite having better preservation of hemoglobin, higher clearance of paraproteins, and higher chances of recovery of renal function than maintenance hemodialysis. We are reporting our short-term experience of five patients with multiple myeloma who presented with renal failure and required long term continuous ambulatory peritoneal dialysis for the treatment of uremia.