| 胡本金,梅冬冬,王富生,等.改良腹腔镜法与传统开腹法的腹膜透析置管术单中心前瞻性非随机对照研究[J].安徽医药,2026,30(8):1577-1583. |
| 改良腹腔镜法与传统开腹法的腹膜透析置管术单中心前瞻性非随机对照研究 |
| A single center prospective non randomized controlled study on peritoneal dialysis catheterization using modified laparoscopic and traditional open abdominal methods |
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| DOI：10.3969/j.issn.1009-6469.2026.08.018 |
| 中文关键词: 导管，留置 腹膜透析 腹腔镜检查 大网膜折叠固定术 导管技术生存率 |
| 英文关键词: Catheters, indwelling Peritoneal dialysis Laparoscopy Greater omentum folding fixation vival |
| 基金项目:安徽省财政支持青年项目( AHWJ2023A30230)；阜阳市重点研究与开发计划项目临床医学研究转化专项项目( FYZDYF2023LCYX002)；阜阳市卫生健康委科研课题青年项目( FY2021-020) |
| 作者 | 单位 | E-mail | | 胡本金 | 安徽医科大学附属阜阳人民医院,肾内科, 安徽阜阳 236000 | | | 梅冬冬 | 安徽医科大学附属阜阳人民医院,肾内科, 安徽阜阳 236000 | | | 王富生 | 安徽医科大学附属阜阳人民医院,普外科,安徽阜阳 236000 | | | 王显 | 安徽医科大学附属阜阳人民医院,肾内科, 安徽阜阳 236000 | | | 李小伟 | 安徽医科大学附属阜阳人民医院,肾内科, 安徽阜阳 236000 | lllxxxwww2005@aliyun.com |
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| 中文摘要: |
| 目的探讨腹腔镜法腹膜透析置管术 +大网膜折叠固定术与传统开腹法腹膜透析置管术的疗效及安全性。方法前瞻性选取安徽医科大学附属阜阳市人民医院 2022年 5月至 2024年 10月住院手术的 117例慢性肾脏病 5期病人，其中 50例采用腹腔镜法腹膜透析置管术 +大网膜折叠固定术(改良腹腔镜组)，67例采用传统开腹法腹膜透析置管术(开腹手术组)并对两组基线资料、手术相关指标、术后并发症及导管技术生存率进行分析比较。结果改良腹腔镜组手术时间( 43.42±12.，74) min、术中出血量( 8.50±3.23)mL、术后疼痛评分( 2.06±0.94)分，均优于开腹手术组［( 54.76±12.66)min、(11.94±3.86)mL、(2.55±1.28)分］(均 P<0.05)；改良腹腔镜组手术费用( 2 860.91±471.22)元和住院费用( 16 877.78±5 761.99)元均高于开腹手术组［( 1 513.15±540.20)元、(14 961.40±3 475.41)元］(均 P<0.05)。改良腹腔镜组导管移位率 2.0%(1/50)、导管阻塞率 0(0/50)及总导管相关并发症发生率 24.0%(12/50)均低于开腹手术组［ 16.4%(11/67)、 11.9%(8/67)、 44.8%(30/67)］(均 P<0.05)。 Kaplan-Meier曲线与 Cox回归模型分析显示，改良腹腔镜组具有更好的导管技术生存率，手术方式是导管生存的独立影响因素。结论腹腔镜法腹膜透析置管术 +大网膜折叠固定术具有创伤小，操作简便，手术时间短，出血少，疼痛轻等优点，显著降低了导管移位率和导管阻塞率等术后并发症，提高了导管技术生存率，值得临床广泛推广。 |
| 英文摘要: |
| Objective To evaluate the efficacy and safety of laparoscopic peritoneal dialysis catheter placement combined with omen-tal folding fixation compared with conventional open peritoneal dialysis catheter placement.Methods Prospective selection of 117 pa-tients with stage 5 chronic kidney disease (CKD) who underwent surgery, Fuyang People's Hospital Affiliated of Anhui Medical Univer-sity, from May 2022 to October 2024, were selected. Among them, 50 patients underwent laparoscopic peritoneal dialysis catheterplacement combined with omental folding fixation (modified laparoscopic group), while 67 patients underwent conventional open perito-neal dialysis catheter placement (open surgery group). Baseline data, surgery-related indicators, postoperative complications, and cathe-ter survival rates were analyzed and compared between the two groups. Results The modified laparoscopic group had significantlyshorter operative duration, less intraoperative blood loss and lower postoperative pain scores compared with the open surgery group[(43.42±12.74) min vs. (54.76±12.66) min, (8.50±3.23) mL vs. (11.94±3.86) mL, (2.06±0.94) points vs. (2.55±1.28) points] (all P<0.05).Surgery costs and hospitalization costs were significantly higher in the modified laparoscopic group than the open surgery group [(2860.91±471.22) yuan vs. (1 513.15±540.20) yuan, (16 877.78±5 761.99) yuan vs. (14 961.40±3 475.41) yuan] (all P<0.05). Moreover,the modified laparoscopic group exhibited significantly lower rates of catheter displacement, catheter obstruction and overall catheter-related complications compared with the open surgery group [2.0% (1/50) vs. 16.4% (11/67), 0 (0/50) vs. 11.9% (8/67), 24.0% (12/50) vs. 44.8% (30/67)] (all P<0.05). Kaplan-Meier and Cox regression analyses showed that the modified laparoscopic group had better cath-eter technique survival, and surgical approach was an independent predictor of catheter survival.Conclusions Laparoscopic peritone-al dialysis catheter placement combined with omental folding fixation offers several advantages, including minimal invasiveness, ease of operation, shorter surgical duration, reduced blood loss, and less postoperative pain. It significantly reduces postoperative complica-tions, such as catheter displacement and blockage rates, improves catheter technical survival rates, and shows great potential for wide-spread clinical application. |
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