背景:腹膜透析(PD)导管插入的理想技术应提供长期有效的导管,直到永久性肾脏替代疗法可用为止。我们在2011年开发了一种使用肾镜辅助单套管针法的技术。在这项研究中,我们报告结果,对肾镜入路与传统腹腔镜入路进行学习曲线分析和成本-效果分析。
方法:在2005年1月至2020年12月之间,我们回顾性分析了511例采用腹腔镜或肾镜入路进行PD导管插入的患者。我们比较了患者的基线特征,手术结果,两组并发症。我们进一步分析了肾镜组,以确定成本-效果分析,在肾镜入路的学习和掌握期之间的学习曲线和并发症频率。
结果:共有208例患者接受了腹腔镜PD导管插入,而303例患者接受了肾镜手术。肾镜组的中位导管生存期明显更长(43.1vs.60.5个月,p=0.019)。腹膜炎的发病率(29.3%vs.20.8%,p=0.035)和出口部位感染(12.5%vs.6.6%,p=0.019)在肾镜组中明显较低。成本效益分析显示,通过使用肾镜技术,医疗费用每年减少16000美元。在检查肾镜技术的学习曲线分析时,学习和掌握阶段之间的手术并发症频率没有差异。
结论:与传统腹腔镜方法相比,肾镜技术通过减少感染并发症,有效延长导管存活时间,降低医疗费用.手术学习阶段的低并发症发生率使手术对患者和外科医生都是安全的。
BACKGROUND: An ideal technique for peritoneal dialysis (PD) catheter insertion should provide a long-term functioning catheter until permanent renal replacement therapy becomes available. We developed a technique using the nephroscope-assisted single-trocar approach in 2011. In this study, we report the outcomes, learning curve analysis and cost-effectiveness analysisof the nephroscopic approach compared with the traditional laparoscopic approach.
METHODS: Between January 2005 and December 2020, we retrospectively reviewed 511 patients who received PD catheter insertions using the laparoscopic or nephroscopic approach. We compared the baseline characteristics of the patients, surgical outcomes, and complications of the two groups. We further analyzed the nephroscopic group to determine the cost-effectiveness analysis, learning curve and the complication frequency between the learning and mastery periods of the nephroscopic approach.
RESULTS: A total of 208 patients underwent laparoscopic PD catheter insertion, whereas 303 patients received nephroscopic surgery. The median catheter survival in the nephroscopic group is significantly longer (43.1 vs. 60.5 months, p = 0.019). The incidence of peritonitis (29.3% vs.20.8%, p = 0.035) and exit site infection (12.5% vs. 6.6%, p = 0.019) were significantly lower in the nephroscopic group. The cost-effectiveness analysis showed a medical expense reduction of 16000 USD annually by using the nephroscopic technique. There was no difference in the frequency of surgical complications between the learning and mastery phases when examining the learning curve analysis for the nephroscopic technique.
CONCLUSIONS: Compared with the traditional laparoscopic approach, the nephroscopic technique effectively prolonged catheter survival and reduces health care cost by reducing infectious complications. The low complication rate during the learning phase of surgery makes the procedure safe for patients and surgeons.