新疆医科大学学报
新疆醫科大學學報
신강의과대학학보
JOURNAL OF XINJIANG MEDICAL UNIVERSITY
2014年
5期
598-602
,共5页
周成明%赵新%张金辉%邰沁文%热娜古丽努尔%温浩
週成明%趙新%張金輝%邰沁文%熱娜古麗努爾%溫浩
주성명%조신%장금휘%태심문%열나고려노이%온호
腹膜透析%腹腔镜%并发症
腹膜透析%腹腔鏡%併髮癥
복막투석%복강경%병발증
peritoneal dialysis%laparoscope%complication
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4 a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 ＜0．05～0．01）；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。
目的：探討腹腔鏡與開腹腹膜透析置管的療效及早期與晚期併髮癥。方法選擇新疆醫科大學第一附屬醫院2009年1月1日-2013年6月1日確診為慢性腎功能衰竭（符閤 CKD5診斷標準）患者135例，根據患者意願選擇手術方式，43例行腹腔鏡腹膜透析置管術（A組），92例行開腹腹膜透析置管術（B組），均採用標準Tenckhoff導管，比較兩組患者手術前後生化指標水平、圍手術期情況、腹膜透析導管（腹透管）使用壽命、術後早期與晚期併髮癥的差異。結果兩組術後肌酐（Scr）、尿素氮（BUN）及血燐水平明顯低于術前，而血紅蛋白（Hb）、血鈣水平明顯高于術前，差異有統計學意義（P ＜0．01）；兩組術後 Scr、BUN、Hb、血鈣及血燐水平比較差異無統計學意義（P ＞0．05）；A組在手術時間、切口長度、術中齣血量及圍手術期疼痛方麵優于 B組，但 A組手術相關費用明顯高于B組，差異有統計學意義（P ＜0．05）；兩組1箇月及6箇月腹透管使用壽命相同，差異無統計學意義（P＞0．05），但 A組1、2、3及4 a腹透管生存率明顯高于B組，差異有統計學意義（P ＜0．05）；B組術後早期併髮癥明顯高于A組，差異有統計學意義（P ＜0．01），主要錶現為早期移位及切口疼痛（P ＜0．05～0．01）；B組晚期移位率、腹透管堵塞率明顯高于 A組，差異有統計學意義（P ＜0．05），兩組腹膜炎、腹壁疝、腹透液滲漏、齣口及隧道感染方麵差異無統計學意義（P ＞0．05）。結論兩種腹膜透析置管術各有利弊。腹腔鏡腹膜透析置管術具有創傷小、腹透管使用壽命長、術後近期與遠期併髮癥髮生率低等優點，值得在臨床推廣應用。但對經濟條件差、心肺功能差而不能耐受全痳及閤併癥多的患者建議選擇開腹置管術。
목적：탐토복강경여개복복막투석치관적료효급조기여만기병발증。방법선택신강의과대학제일부속의원2009년1월1일-2013년6월1일학진위만성신공능쇠갈（부합 CKD5진단표준）환자135례，근거환자의원선택수술방식，43례행복강경복막투석치관술（A조），92례행개복복막투석치관술（B조），균채용표준Tenckhoff도관，비교량조환자수술전후생화지표수평、위수술기정황、복막투석도관（복투관）사용수명、술후조기여만기병발증적차이。결과량조술후기항（Scr）、뇨소담（BUN）급혈린수평명현저우술전，이혈홍단백（Hb）、혈개수평명현고우술전，차이유통계학의의（P ＜0．01）；량조술후 Scr、BUN、Hb、혈개급혈린수평비교차이무통계학의의（P ＞0．05）；A조재수술시간、절구장도、술중출혈량급위수술기동통방면우우 B조，단 A조수술상관비용명현고우B조，차이유통계학의의（P ＜0．05）；량조1개월급6개월복투관사용수명상동，차이무통계학의의（P＞0．05），단 A조1、2、3급4 a복투관생존솔명현고우B조，차이유통계학의의（P ＜0．05）；B조술후조기병발증명현고우A조，차이유통계학의의（P ＜0．01），주요표현위조기이위급절구동통（P ＜0．05～0．01）；B조만기이위솔、복투관도새솔명현고우 A조，차이유통계학의의（P ＜0．05），량조복막염、복벽산、복투액삼루、출구급수도감염방면차이무통계학의의（P ＞0．05）。결론량충복막투석치관술각유리폐。복강경복막투석치관술구유창상소、복투관사용수명장、술후근기여원기병발증발생솔저등우점，치득재림상추엄응용。단대경제조건차、심폐공능차이불능내수전마급합병증다적환자건의선택개복치관술。
Objective To compare the effect,early and late complications between the placement of perito-neal dialysis (PD)catheters under laparoscope and open surgical method in patients with chronic kidney disease grade 5 (CKD grade 5 ).Methods A total of 1 3 5 patients diagnosed as CKD grade 5 in the First Affiliated Hospital of Xinjiang Medical University from January 2009 to June 2013 were analyzed retro-spectively.43 patients underwent laparoscope (group A)and 92 underwent 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 1 ate 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 1 month and 6 months after operation between the two groups (P >0.05),but PD catheters survival rate in group A was higher in 1a,2a,3a and 4a than that in group B (P <0.05).Early complications in group A was less than that in group B (P <0.01),especially the re-moval 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 condi-tions and poor cardiopulmonary function.
