摘要
目的 探讨输尿管软镜引导腹膜透析管(腹透管)置入的可行性.方法 回顾性分析 2019 年 5 月～2023 年3 月终末期肾病 54 例腹透管置入的临床资料,由患者选择置入方法,常规组 23 例应用金属导丝引导腹透管置入,软镜组 31例应用输尿管软镜代替导丝引导腹透管置入.比较2 组手术成功率、手术时间、术后应用止痛药、腹透管相关并发症和术后肌酐下降等指标.结果 2 组均置管成功,软镜组腹透管相关并发症总发生率低于常规组[6.5%(2/31)vs.30.4%(7/23),χ2 =3.878,P =0.049].2 组手术时间、术后应用止痛药、术后2 周肌酐下降值差异均无统计学意义(P>0.05).2 组术后中位随访时间10 个月(3～24 个月),未见腹透液渗漏、肠穿孔、腹腔内出血等并发症.结论 输尿管软镜代替导丝引导腹透管置入,安全,可视,定位准确,可以降低腹透管相关并发症,并可以发现和处理腹腔内合并症.
Abstract
Objective To explore the feasibility of peritoneal dialysis catheter placement assisted by flexible ureteroscope.Methods A retrospective analysis was conducted on clinical data of 54 cases of end-stage renal disease receiving peritoneal dialysis catheter placement from May 2019 to March 2023.The placement method was chosen by the patient.In the conventional group,23 cases were guided by a metal guide wire for insertion of the peritoneal dialysis catheter,while in the flexible ureteroscope group,31 cases were guided by flexible ureteroscope instead of guide wire for insertion of the peritoneal dialysis catheter.The success rate of catheterization,surgical time,use of postoperative analgesic,complications related to peritoneal dialysis catheter,and postoperative creatinine decrease were compared between the two groups.Results The catheter placement was successfully performed in both groups.The total incidence of complications related to peritoneal dialysis catheter in the flexible ureteroscope group was lower than that in the conventional group[6.5%(2/31)vs.30.4%(7/23),χ2 =3.878,P =0.049].Between the conventional group and the flexible ureteroscope group,there were no statistically significant differences in the surgical time,postoperative analgesic usage,and the decrease of creatinine at 2 weeks after surgery(P>0.05).The median postoperative follow-up period was10 months(range,3-24 months)in the two groups,and there were no complications such as peritoneal leakage,intestinal perforation,or intraperitoneal bleeding.Conclusion The placement of peritoneal dialysis catheter guided by the flexible ureteroscope instead of metal guide wire is a safe,visible,and accurate method,which can reduce complications related to peritoneal dialysis catheter,and detect and manage comorbidities in the abdominal cavity.
基金项目
上海市科学技术委员会医学创新研究专项(22Y11922700)
上海市卫生健康委员会卫生行业临床研究专项(202240386)
上海中医药大学预算内项目(2021LK063)
NETL
NSTL
维普
万方数据