腹部小手术史患者单通道输尿管镜辅助下腹膜透析管置入技术的应用

目的 探讨既往有腹腔小手术史患者单通道输尿管镜辅助下腹膜透析管置入技术临床应用的安全性及其意义.方法 选择既往有腹部小手术史的终末期肾脏病患者13例,所有患者均自愿选择腹膜透析替代治疗,使用Peer-Away鞘建立腹腔单通道,输尿管镜进入腹腔,观察腹腔内是否存在粘连,并酌情分离粘连,将腹膜透析管放置于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 13例患者中12例见腹腔内粘连,通过输尿管镜简单分离粘连并直视下置管,所有腹膜透析管均放置成功,手术时间（44 ±13）分钟,术中追加麻药（15±6）ml,术中出血极少,无出血导致输血情况发生.所有患者随访时间6个月,腹膜透析顺利,未见漂管、渗漏、堵管等并发症.结论 既往有腹部小手术史患者,单通道输尿管镜辅助下腹膜透析管定位精确,安全可靠,并发症少,有助于观察腹腔内情况,并可酌情分离腹腔内粘连.

The clinical application of placement of peritoneal dialysis catheters assisted by one-port ureteroscope in patients with history of abdominal operation

Objective To evaluate the clinical feasibility and effect of placement of peritoneal dialysis catheters assisted by one-port ureteroscope in patients with history of abdominal operation.Methods Thirteen chronic renal failure patients with history of small abdominal operation were recruited.All patients underwent peritoneal dialysis as replacement therapy.Ureteroscopic monitoring was performed through an incision near the umbilicus with a peer-away sheath toward the bladder and rectum.Observed adhesions within the peritoneal cavity were separated.The catheter was passed through the peer-away sheath into the the true pelvis.A subcutaneous tunnel was created and a point in left lower quadrant was selected as the exit site of the catheter.Results 12 of 13 patients required adhesiolysis.Adhesions were easily dissected with scissors by ureteroscope.All the catheters were successfully placed and the mean operative time was 44 ± 13 minutes.The mean total dose of local anesthetic was 15 ± 6 ml.Less bleeding and no blood transfusion.After a mean follow-up time of 6 months,12 catheters were still functioning properly.There were no catheter-related complications,such as catheter migration,dialysate leakage and blockage.Conclusion Insertion technique assisted by one-port ureteroscope is a safe and effective method for the placement of peritoneal dialysis catheters.Especially,some cases with mild adhesions can be easily dissected with scissors through the working channel of the ureteroscope.