腹膜透析导管徒手薅除术与手术切开拔管术的疗效对比

doi:10.3969/j.issn.1004-583X.2021.12.008

摘要/Abstract

摘要：

目的比较腹膜透析导管徒手薅除术与手术切开拔管术的疗效, 为临床诊疗提供依据。方法回顾性分析2011-2020年在江苏大学附属医院行腹膜透析导管拔除术患者88例。徒手薅除术39例,手术切开术49例。比较两组术中及术后并发症,对徒手薅除的腹膜透析导管进行拉力测试,探讨导管耐受拉力情况。结果徒手薅除术组手术时间、术中疼痛评分、出血量较多(>10 ml)患者数均小于外科切开组(P<0.05)。两组感染发生率相似。导管断裂时所承受的拉力随导管寿命延长而下降。结论腹膜透析导管徒手薅除术便捷、安全,值得推广。

关键词: 腹膜透析, 手术中并发症, 手术后并发症

Abstract:

Objective To compare the effecacy of pull and surgical technique for removal of peritoneal dialysis (PD) catheter. Methods We retrospectively analyzed 88 patients undergone PD catheter removal admitted to Affiliated Hospital of Jiangsu University during the past decade (2011-2020). intra-operative and post-operative were performed on the two groups which comprised 39 (pull technique) and 49 (surgical technique) patients. The tension test of the catheter in pull technique group was conducted to explore resistance of PD catheter. Results In comparative trials, operating duration, pain score and proportion of patients with blood loss than 10 ml of pull technique patients were less than those of surgical technique patients (P<0.05); Similar infection rate was found between groups; decreased fracture (pull) in PD catheter was in opposite to its life extension. Conclusion Pull technique for PD catheter is convenient and safe then worthy of promotion.

Key words: peritoneal dialysis, intraoperative complications, postoperative complications

中图分类号:

R459.5

程慧栋, 司博林, 华琴, 何建强, 桂兰兰. 腹膜透析导管徒手薅除术与手术切开拔管术的疗效对比[J]. 临床荟萃, 2021, 36(12): 1097-1101.

Cheng Huidong, Si Bolin, Hua Qin, He Jianqiang, Gui Lanlan. Efficacy comparison between pull and surgical technique for removal of peritoneal dialysis catheter[J]. Clinical Focus, 2021, 36(12): 1097-1101.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.12.008

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I12/1097

图/表 8

参考文献 19

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项目	外科手术切开组(n=49)	徒手薅除术组(n=39)	统计值	P值
年龄(岁)	49.59±13.08	52.38±12.78	t=1.005	0.318
性别[例(%)]
男女	30(61.2) 19(38.8)	26(66.7) 13(33.3)	χ²=0.278	0.598
PD导管放置时间(月)	47.63±22.47	61.74±32.24	t=2.321	0.023
BMI(kg/m²)	21(20, 24)	21(20, 23)	Z=-0.897	0.370
白细胞(×10⁹/L)	6.6(5.2,8.5)	6.7 (5.7,7.7)	Z=-0.307	0.759
血红蛋白(g/L)	100.29±22.78	93.36±19.89	t=-1.497	0.138
血小板(×10⁹/L)	181.49±68.93	197.23±70.77	t=1.052	0.296
血清白蛋白(g/L)	34.96±7.84	32.49±7.57	t=-1.493	0.139
拔管原因[例(%)]
腹膜炎	18(36.7)	12(30.8)	χ²=0.34	0.558
肾移植	2(4.1)	2(5.1)	χ²=0.055	0.815
透析不充分	29(59.2)	25(64.1)	χ²=0.222	0.638

项目	外科手术切开组(n=49)	徒手薅除术组(n=39)	统计值	P值
年龄(岁)	49.59±13.08	52.38±12.78	t=1.005	0.318
性别[例(%)]
男女	30(61.2) 19(38.8)	26(66.7) 13(33.3)	χ²=0.278	0.598
PD导管放置时间(月)	47.63±22.47	61.74±32.24	t=2.321	0.023
BMI(kg/m²)	21(20, 24)	21(20, 23)	Z=-0.897	0.370
白细胞(×10⁹/L)	6.6(5.2,8.5)	6.7 (5.7,7.7)	Z=-0.307	0.759
血红蛋白(g/L)	100.29±22.78	93.36±19.89	t=-1.497	0.138
血小板(×10⁹/L)	181.49±68.93	197.23±70.77	t=1.052	0.296
血清白蛋白(g/L)	34.96±7.84	32.49±7.57	t=-1.493	0.139
拔管原因[例(%)]
腹膜炎	18(36.7)	12(30.8)	χ²=0.34	0.558
肾移植	2(4.1)	2(5.1)	χ²=0.055	0.815
透析不充分	29(59.2)	25(64.1)	χ²=0.222	0.638

项目	外科手术切开组(n=49)	徒手薅除术组(n=39)	统计值	P值
拔管时间(min)	33.82±7.19	15.28±4.45	t=14.82	0.000
NRS评分(分)	4.86±1.04	2.03±0.74	t=14.87	0.000
术中出血量[例(%)]
<5 ml	2(4.1)	12(30.8)	χ²=9.650	0.002
5~10 ml	31(63.3)	26(66.7)	χ²=0.110	0.740
>10 ml	16(32.7)	1(2.5)	χ²=12.61	0.000
术后感染[例(%)]
PD导管出口处感染	0	0
深涤纶套处感染	0	2(5.1)	χ²=1.300	0.437
手术切口感染	2(4.1)	0	χ²=1.630	0.501
PD导管隧道感染	0	0
肾移植术后感染	0	0
腹膜炎术后感染	0	0
新发腹膜炎	0	0
腹部疝[例(%)]	0	0
导管断裂[例(%)]	0	1(2.6)	χ²=1.270	0.443
拔管成功[例(%)]	49(100.0)	38(97.4)	χ²=1.270	0.443

项目	外科手术切开组(n=49)	徒手薅除术组(n=39)	统计值	P值
拔管时间(min)	33.82±7.19	15.28±4.45	t=14.82	0.000
NRS评分(分)	4.86±1.04	2.03±0.74	t=14.87	0.000
术中出血量[例(%)]
<5 ml	2(4.1)	12(30.8)	χ²=9.650	0.002
5~10 ml	31(63.3)	26(66.7)	χ²=0.110	0.740
>10 ml	16(32.7)	1(2.5)	χ²=12.61	0.000
术后感染[例(%)]
PD导管出口处感染	0	0
深涤纶套处感染	0	2(5.1)	χ²=1.300	0.437
手术切口感染	2(4.1)	0	χ²=1.630	0.501
PD导管隧道感染	0	0
肾移植术后感染	0	0
腹膜炎术后感染	0	0
新发腹膜炎	0	0
腹部疝[例(%)]	0	0
导管断裂[例(%)]	0	1(2.6)	χ²=1.270	0.443
拔管成功[例(%)]	49(100.0)	38(97.4)	χ²=1.270	0.443

	直管+鹅颈管直部 (n=38)	鹅颈管鹅颈部(n=5)	t值	P值
0~3年	121.27±1.55(11)	117.70±2.02(3)	3.25	0.031
4~6年	116.66±3.30(17)^*	98.40±2.42(2)^*	10.23	0.001
7~9年	108.83±2.52(9)^*#	-	-	-
≥10年	105.21(1)^*	-	-	-