背景:腹膜透析(PD)导管的故障仍然是一个棘手的问题。开发了一种改良的开放式手术翻修技术,该技术具有缝合固定且无需拔除导管的故障导管,以评估同时导管置换技术之间的有效性和安全性。
方法:回顾性分析167例PD导管故障患者。为了抢救PD导管,患者接受改良开放手术翻修术(A组)或同时导管置换术(B组).术前基线特征,围手术期情况,比较两组的并发症和结局.
结果:A组患者的手术时间明显缩短(67.4±22.1比82.8±21.1分钟,p=0.009),术后24小时内疼痛评分较少(中位数为0.0对2.0,p<0.001),更快开始PD(1.06±0.31对1.89±0.89天,p<0.001),住院时间较短(9.89±5.11对12.55±7.37天,p=0.020)比B组好。在并发症方面,A组导管故障复发发生率明显低于B组(1/114vs12/53,p<0.001).在机械并发症方面没有显着差异(血性流出物,透析液泄漏,和疝气)和早期腹膜炎。与B组相比,A组患者的导管生存率较高(log-rank,p=0.004)。
结论:我们改良的开放手术翻修技术是一种安全的,简单快速的方法,并提供更好的结果,导管故障复发风险最小,无需额外的成本和设备。该技术值得临床推广应用。
Backgrounds: The malfunction of peritoneal dialysis (PD) catheter is still an intractable problem. A modified open surgical revision technique with suturing fixation and without catheter removal for malfunctioning catheter was developed to evaluated the efficacy and safety between simultaneous catheter replacement technique.
Methods: A total of 167 PD patients with malfunctioning catheter were retrospectively reviewed. For the salvage of PD catheters, patients underwent modified open surgical revision (group A) or simultaneous catheter replacement (group B). The baseline characteristics before operation, perioperative condition, complications and outcomes were compared between both groups.
Results: Patients of group A showed significantly shorter operative time (67.4 ± 22.1 versus 82.8 ± 21.1 min, p = 0.009), less postoperative pain score within 24 h (median 0.0 versus 2.0, p < 0.001), quicker start of PD (1.06 ± 0.31 versus 1.89 ± 0.89 days, p < 0.001), shorter length of stay (9.89 ± 5.11 versus 12.55 ± 7.37 days, p = 0.020) than group B. In terms of complications, the incidence of recurred catheter malfunction in group A was significantly lower than those in group B (1/114 versus 12/53, p < 0.001). There were no significant differences in mechanical complications (bloody effluent, dialysate leakage, and hernia) and early peritonitis between the groups. The group A patients had a favorable catheter survival rate compared with group B (log-rank, p = 0.004).
Conclusions: Our modified open surgical revision technique is a safe, simple and fast method, and offers a better outcome with minimal risk of recurrence of catheter malfunction without additional cost and equipment. This technique is worthy of clinical application.