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目的:探讨输尿管镜辅助下腹膜透析管置入技术的临床应用安全性和疗效。方法:自愿选择腹膜透析替代治疗的终末期肾病患者32例,局麻下采用经皮微创穿刺技术,使用Peer-Away鞘建立腹腔通道,以输尿管镜进入腹腔内定位,并引导腹膜透析管置于膀胱直肠窝或子宫直肠窝,近端建立皮下隧道并经左下腹戳洞引出。结果:全部患者腹膜透析管均放置成功,手术时间(42±15)min,术中用20%盐酸利多卡因(13±5)ml,出血极少,仅4例术后出现淡血性腹水,腹水持续时间约(16±5)h,无因出血导致输血者。术后随访时间≥12月,均未见漂管、渗漏、堵管等腹膜透析常见并发症。结论:输尿管镜辅助下腹膜透析管置入技术是一种定位精确、安全可靠、并发症少的置管新方法,值得推广应用。
Objective: To investigate the safety and efficacy of ureteroscopic assisted peritoneal dialysis catheter implantation. Methods: Thirty-two patients with end-stage renal disease who were surgically replaced by peritoneal dialysis were selected. Under local anesthesia, percutaneous minimally invasive technique was used to establish abdominal passage with Peer-Away sheath. Ureteroscopy was used to locate intraperitoneally and peritoneal dialysis tube In the bladder rectum or uterine rectal fossa, the establishment of a subcutaneous tunnel near the lower left abdominal puncture hole leads to. Results: All the peritoneal dialysis tubes were placed successfully, the operation time was 42 ± 15 min, the intraoperative use of 20% lidocaine hydrochloride was (13 ± 5) ml, bleeding was minimal. Only 4 patients had pale bloody ascites, Ascites duration of about (16 ± 5) h, no bleeding due to blood transfusion. Postoperative follow-up time ≥ 12 months, no drift, leakage, plugging and other common complications of peritoneal dialysis. Conclusion: The ureteroscopic assisted peritoneal dialysis catheter implantation is a new method of catheterization with accurate positioning, safe and reliable, and less complications. It is worth popularizing and applying.