Laparoscopic peritoneal dialysis catheter insertion using rectus sheath tunnel and selective omentopexy significantly reduces catheter dysfunction and increases peritoneal dialysis longevity
Laparoscopic peritoneal dialysis catheter insertion using rectus sheath tunnel and selective omentopexy significantly reduces catheter dysfunction and increases peritoneal dialysis longevity
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DOI：
10.1016/j.surg.2016.06.005
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发表时间：
2016-10-01
期刊：
影响因子：
3.8
通讯作者：
Haggerty, Stephen P.
中科院分区：
文献类型：
--
作者：
Krezalek, Monika A.;Bonamici, Nicolas;Haggerty, Stephen P.
背景资料。腹膜透析的成功取决于腹膜透析导管的耐用性，而后者又取决于插入技术。导管相关并发症是腹膜透析失败的主要原因之一。显示导管功能改善的技术包括直肌鞘隧道、选择性网膜固定术和粘连松解术。对2004至2014年间连续放置腹膜透析导管的单一机构进行了回顾。在235例手术中，63例采用开放手术，80例采用基础腹腔镜联合选择性粘连松解术，92例采用直肌鞘隧道、选择性网膜固定术和粘连松解术。主要结果包括导管功能障碍、导管功能障碍消失和总存活率。机械导管功能障碍，晚期腹腔镜组4例(4.4%)，基础腹腔镜组14例(17.5%)，开腹组20例(31.8%)(P<；0.01)。晚期腹腔镜组的无功能障碍率和总体导管存活率最高。直肌鞘隧道的保护作用与无功能障碍的导管存活期无关。晚期腹腔镜组改用血液透析率也显著低于非腹腔镜组(P=0.031)。使用直肌鞘隧道、选择性大网膜固定术和粘连松解术的先进的腹腔镜腹膜透析导管插入术可以减少导管功能障碍的发生率，改善无功能和总的导管存活率，并降低改用血液透析的比率。
Background. Success of peritoneal dialysis depends on the durability of the peritoneal dialysis catheter, which in turn depends on insertion technique. Catheter-related complications are among the main reasons for peritoneal dialysis failure. Techniques showing evidence of improved catheter function include rectus sheath tunnel, selective omentopexy, and adhesiolysis.Methods. Single-institution retrospective review of consecutive peritoneal dialysis catheter insertions was performed between 2004 and 2014. Of 235 procedures, the open technique was utilized in 63, basic laparoscopy with selective adhesiolysis in 80, and advanced laparoscopy utilizing rectus sheath tunnel, selective omentopexy, and adhesiolysis in 92. Primary outcomes included catheter dysfunction, catheter dysfunction-free, and overall survival.Results. Mechanical catheter dysfunction occurred in 4 patients (4.4%) in the advanced laparoscopy group, 14 (17.5 %) in the basic laparoscopy group, and 20 (31.8%) in the open group (P < .01). The advanced laparoscopy group had the highest rate of dysfunction-free and overall catheter survival. The rectus sheath tunnel was protective independently of dysfunction free catheter survival. The rate of switch to hemodialysis also was significantly lower in the advanced laparoscopic group (P = .031).Conclusion. Advanced laparoscopic peritoneal dialysis catheter insertion using rectus sheath tunnel, selective omentopexy, and adhesiolysis is associated with decreased catheter dysfunction rates, improved dysfunction-free and overall catheter survival, and lowest rate of switch to hemodialysis.