新疆医科大学学报

目的探讨腹腔镜与开腹腹膜透析置管的疗效及早期与晚期并发症。方法选择新疆医科大学第一附属医院2009年1月1日-2013年6月1日确诊为慢性肾功能衰竭(符合CKD5诊断标准)患者135例,根据患者意愿选择手术方式,43例行腹腔镜腹膜透析置管术(A组),92例行开腹腹膜透析置管术(B组),均采用标准Tenckhoff导管,比较两组患者手术前后生化指标水平、围手术期情况、腹膜透析导管(腹透管)使用寿命、术后早期与晚期并发症的差异。结果两组术后肌酐(Scr)、尿素氮(BUN)及血磷水平明显低于术前,而血红蛋白(Hb)、血钙水平明显高于术前,差异有统计学意义(P<0.01);两组术后Scr、BUN、Hb、血钙及血磷水平比较差异无统计学意义(P>0.05);A组在手术时间、切口长度、术中出血量及围手术期疼痛方面优于B组,但A组手术相关费用明显高于B组,差异有统计学意义(P<0.05);两组1个月及6个月腹透管使用寿命相同,差异无统计学意义(P>0.05),但A组1、2、3及4a腹透管生存率明显高于B组,差异有统计学意义(P<0.05);B组术后早期并发症明显高于A组,差异有统计学意义(P<0.01),主要表现为早期移位及切口疼痛(P<0.05⁰.01);B组晚期移位率、腹透管堵塞率明显高于A组,差异有统计学意义(P<0.05),两组腹膜炎、腹壁疝、腹透液渗漏、出口及隧道感染方面差异无统计学意义(P>0.05)。结论两种腹膜透析置管术各有利弊。腹腔镜腹膜透析置管术具有创伤小、腹透管使用寿命长、术后近期与远期并发症发生率低等优点,值得在临床推广应用。但对经济条件差、心肺功能差而不能耐受全麻及合并症多的患者建议选择开腹置管术。

Objective To compare the effect,early and late complications between the placement of peritoneal dialysis(PD)catheters under laparoscope and open surgical method in patients with chronic kidney disease grade 5(CKD grade 5).Methods A total of 135patients diagnosed as CKD grade 5in the First Affiliated Hospital of Xinjiang Medical University from January 2009to June 2013were analyzed retrospectively.43patients underwent laparoscope(group A)and 92underwent open surgical method(group B)based on patients′decisions.The standard straight Tenckhoff catheter was used for all patients.The effect,peri-operative items,PD catheter survival,early and 1ate complications were compared between the two groups.Results Serum creatinine,blood urea nitrogen,and serum phosphorus were reduced after the operation in two groups.Hemoglobin and calcium were increased after the operation in two groups(P < 0.01).There were no differences in serum creatinine,blood urea nitrogen,serum phosphorus,hemoglobin and calcium after the operation between the two groups(P >0.05).The Laparoscopic procedure was faster than open surgical method(P <0.05).The length of the incision in group A was shorter than that in group B(P <0.05).The bleeding in group A was less than that in group B(P <0.05),more patients feel pain in group B(P <0.05),but the expense in group A was more than that in group B(P <0.05). There was no difference in PD catheters survival within 1month and 6months after operation between the two groups(P >0.05),but PD catheters survival rate in group A was higher in 1a,2a,3aand 4athan that in group B(P <0.05).Early complications in group A was less than that in group B(P <0.01),especially the removal rate and the incision pain rate in group A were lower than that in group B.The incidences of catheter displacement and catheter obstruction in group A were less than that in group B(P <0. 05),the incidences of peritonitis,abdominal hernia,leakage and exit-site infections were indifferent between the two groups(P >0.05).Conclusion The two methods has their own advantages.The placement of PD catheter under laparoscope has the advantages of less pain,longer PD catheters survival and lower incidence of early and late complications.However,open surgical method is suitable for these patients with poor economic conditions and poor cardiopulmonary function.