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目的探讨腹腔镜下腹膜透析置管术治疗终末期肾脏疾病的临床疗效及安全性。方法行腹腔镜下腹膜透析置管术治疗的终末期肾病患者175例。首次置管130例,传统置管术后再次置管45例。记录患者术后疼痛评分,随访期间有无隧道感染、置管堵塞、置管移位、重新置管率等相关指标。结果 175例患者均在腹腔镜下顺利完成手术,无中转开腹患者。手术时间30~60分钟,平均45.6分钟;术后3~9天出院,平均4.5天。随访时间3~36个月,平均20.4个月。使用肝素水于术后第2天开始冲洗置管,于术后4~9天后开始透析。4例患者进行腹膜透析治疗时流出淡血性液体,均于术后5~7天消失。患者术后疼痛评分(2.13±0.73)分,术后发生切口感染4例,均经换药处理后痊愈出院。2例患者分别于术后4个月、6个月因隧道口感染行腹膜透析置管取出术,随访过程中未发现导管移位、导管阻塞等情况,临床效果良好。结论腹腔镜下腹膜透析置管术与传统开腹手术比较,切口感染发生率低,并发症少,疼痛轻,恢复快。
Objective To investigate the clinical efficacy and safety of laparoscopic peritoneal dialysis catheter in the treatment of end-stage renal disease. Methods 175 patients with end-stage renal disease treated by laparoscopic peritoneal dialysis. The first catheter in 130 cases, traditional catheterization after re-catheterization in 45 cases. Record the postoperative pain score, whether there is tunnel infection during follow-up, occlusion, catheter displacement, re-catheterization rate and other related indicators. Results 175 patients underwent laparoscopic surgery without laparotomy. The operation time was 30-60 minutes, with an average of 45.6 minutes. The patients were discharged from hospital after 3 to 9 days with an average of 4.5 days. Follow-up time of 3 to 36 months, an average of 20.4 months. Heparinized water was used to flush the catheter on day 2 postoperatively and dialysis was initiated 4 to 9 days after surgery. 4 cases of peritoneal dialysis treatment out of bloody fluid, were in 5 to 7 days after the disappearance. Patient postoperative pain score (2.13 ± 0.73) points, 4 cases of incision infection occurred after surgery, were discharged after treatment by dressing. Two patients underwent peritoneal dialysis after 4 months and 6 months postoperatively respectively. Catheter displacement and catheter obstruction were not observed during the follow-up. The clinical effect was good. Conclusion Laparoscopic peritoneal dialysis compared with the traditional open surgery, incision infection rate is low, less complications, pain, fast recovery.