联合垂直隧道的低位腹膜透析导管置入法构建及效果

目的 构建联合垂直隧道的低位腹膜透析（peritoneal dialysis,PD）导管置入法并观察其临床效果.方法 2008年6月至2012年6月行联合垂直隧道的低位PD导管置入术的48例患者（B组）与同期行传统PD导管置入术的41例患者（A组）进行对照研究.所有患者均使用Baxter双涤纶套Tenck-hoff直管.联合垂直隧道的低位PD导管置入法的主要特点是低位（耻骨联合中点向上7cm）、导管腹内段剪短根据腹膜切口至膀胱直肠窝（男）或子宫直肠窝（女）的距离]以及增加垂直的皮下隧道.术中记录所有患者PD导管修剪距离及腹内段长度.观察记录所有患者随访1年内有无并发症发生.结果 B组测量的导管修剪距离为（3.7±0.9） cm,腹内段长度为（11.3±0.9）cm.2组患者术后出血、PD液渗漏、外涤纶套膨出外露、灌液或放液疼痛等发生率以及腹膜炎发生次数/病人月、隧道炎或出口感染发生次数/患者月等方面比较无统计学差异;B组导管功能障碍（导管移位、非导管移位性功能障碍）发生率显著低于A组,差异有统计学意义（4.2％比19.5％,x2=2.54,P0.0l0）. 结论 联合垂直隧道的低位PD导管置入法可以显著地减少PD导管功能障碍尤其是导管移位的发生,具有潜在减少PD技术性失败的重要作用.

The Establishment and Effect of Combined Vertical Tunnel with Low-site Peritoeal Dialysis Catheter Placement

Objective To evaluate the effect of combined vertical tunnel with low-site peritoneal dialysis catheter placement on catheter-related malfunction.Methods During the period from June 2008 to June 2012,48 patients received the operation of combined vertical tunnel with low-site peritoneal dialysis catheter placement （Group B） and 41 patients received the traditional open surgery （Group A）.The Group A surgery was characterized by a low incision site,a shortened intra-abdominal catheter segment and an additional vertical subcutaneous tunnel.The distance of the shortened intra-abdominal catheter segment was measured during the operation.All patients were followed up for 1 year after surgery.Catheter-related complications were analyzed.Results The distance of the shortened intra-abdominal catheter segment was （11.3±0.9） cm.Catheter malfunction was the most frequent mechanical complication,found in 8 patients （19.5％） in Group A.Only 2 episodes （4.2％） of catheter malfunction were found in Group B,representing a rate significantly less than those in Group A （x2=2.54,P=0.010）.There was no significant difference in the episodes of leakage,inflow or outflow pain,bleeding,outer cuff extrusion and infectious complications between the two groups （P＞0.05）.Conclusion The combined vertical tunnel with low-site peritoneal dialysis catheter placement can effectively prevent catheter malfunction and is a reliable method for the peritoneal dialysis patients.