Chen Liang,Wang Qi,Xiang Bo.Laparoscopic peritoneal dialysis catheter placement combined with subtotal omentectomy in children with end-stage renal disease[J].Journal of Clinical Pediatric Surgery,2025,(07):652-657.[doi:10.3760/cma.j.cn101785-202411037-010]
腹腔镜下腹膜透析置管联合大网膜次全切除术在儿童终末期肾病中的应用
- Title:
- Laparoscopic peritoneal dialysis catheter placement combined with subtotal omentectomy in children with end-stage renal disease
- Keywords:
- Laparoscopes; Peritoneal Dialysis; Kidney System Diseases; Surgical Procedures; Operative; Child
- 摘要:
- 目的 初步探讨腹腔镜下腹膜透析置管联合大网膜次全切除术在儿童终末期肾病治疗中的应用,总结相关并发症及其防治经验。方法 回顾性分析2016年1月至2024年3月在四川大学华西医院小儿外科接受腹腔镜下腹膜透析置管联合大网膜次全切除术治疗的38例终末期肾病患儿临床资料,总结患儿的基本信息、原发疾病、手术时长、术前及术后肾功能、术后并发症(感染、堵管、漂管、漏液、腹部疝)、是否肾移植及死亡、导管存活率及使用时长,并进行统计分析。结果 纳入研究的38例患儿中,男性21例、女性17例,总体并发症发生率为28.9%(11/38)。其中腹腔感染6例(15.8%,6/38),5例经抗感染治疗无效后再次手术拔除导管,1例则在抗感染治疗后继续正常使用导管;导管漂移3例(7.9%,3/38),其中2例行再次手术置管,1例继续使用导管8个月后死亡;术后堵管、漏液各1例(2.6%,1/38),均再次手术处理。共3例(7.9%,3/38)患儿在导管使用期间死亡,20例(52.6%,20/38)患儿接受肾移植治疗,剔除对应年限肾移植病例术后1年、2年、3年的导管存活率分别为81.6%(31/38)、66.7%(22/33)、60.7%(17/28);3例患儿使用导管超过6年,且无并发症发生;所有患儿导管使用时长为(23.11±20.73)个月。结论 对于儿童终末期肾病,腹腔镜下腹膜透析置管联合大网膜次全切除术是一种安全、可靠的肾脏替代治疗方式;腹腔感染是最常见的并发症,也是造成导管失效的主要原因,临床应加强对腹腔感染的防控。
- Abstract:
- Objective To preliminarily explore the application of laparoscopic peritoneal dialysis catheter placement combined with subtotal omentectomy in children with end-stage renal disease,and to summarize and analyze related complications and experience in their prevention and management. Methods A retrospective analysis was conducted on the clinical data of 38 children with end-stage renal disease who underwent laparoscopic peritoneal dialysis catheter placement combined with subtotal omentectomy at the Department of Pediatric Surgery,West China Hospital of Sichuan University,from January 2016 to March 2024.Data collected included demographics,primary disease,operative time,pre-and postoperative renal function,postoperative complications (infection,catheter blockage,migration,leakage,abdominal hernia),renal transplantation and mortality,catheter survival rate,and usage duration. Results Among the 38 patients,21 were male and 17 female.The overall complication rate was 28.9% (11/38).Peritonitis occurred in 6 patients (15.8%); 5 required catheter removal due to ineffective anti-infective treatment,while 1 continued using the catheter after successful treatment.Catheter migration occurred in 3 patients (7.9%); 2 underwent reoperation for catheter replacement,and 1 continued catheter use for 8 months before death.One case each of catheter blockage and leakage was reported (2.6% each),both managed surgically.3 patients (7.9%) died during catheter use.20 patients (52.6%) underwent renal transplantation.After excluding transplant recipients for each year,the 1-,2-,and 3-year catheter survival rates were 81.6% (31/38),66.7% (22/33),and 60.7% (17/28),respectively.3 patients used the catheter for more than 6 years without complications.The duration of catheter use was 23.11±20.73 months. Conclusions Laparoscopic peritoneal dialysis catheter placement combined with subtotal omentectomy is a safe and reliable surgical renal replacement therapy for children with end-stage renal disease.Peritonitis is the most common complication and the leading cause of catheter failure,highlighting the need for enhanced prevention and control strategies.
参考文献/References:
[1] Regunathan-Shenk R,Hussain FN,Ganda A.Chronic kidney disease and end-stage renal disease in disadvantaged communities of North America:an investigational challenge to limit disease progression and cardiovascular risk[J].Clin Nephrol,2016,86(S1):37-40.DOI:10.5414/CNP86S114.
[2] 沈茜,方晓燕,孙玉,等.维持性腹膜透析和血液透析治疗儿童终末期肾病的临床分析和疗效比较[J].中国血液净化,2019,18(6):402-405.DOI:10.3969/j.issn.1671-4091.2019.06.007. Shen Q,Fang XY,Sun Y,et al.A comparative study of peritoneal dialysis and hemodialysis for end-stage renal disease children[J].Chin J Blood Purif,2019,18(6):402-405.DOI:10.3969/j.issn.1671-4091.2019.06.007.
[3] 庞亚昌,徐卓明,张明杰,等.腹膜透析在小儿先天性心脏病手术后的应用[J].临床小儿外科杂志,2021,20(8):743-748.DOI:10.12260/lcxewkzz.2021.08.008. Pang YC,Xu ZM,Zhang MJ,et al.Application and effect of peritoneal dialysis in children after congenital heart surgery[J].J Clin Ped Sur,2021,20(8):743-748.DOI:10.12260/lcxewkzz.2021.08.008.
[4] Schaefer F,Warady BA.Peritoneal dialysis in children with end-stage renal disease[J].Nat Rev Nephrol,2011,7(11):659-668.DOI:10.1038/nrneph.2011.135.
[5] Schwartz GJ,Haycock GB,Edelmann CM Jr,et al.A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine[J].Pediatrics,1976,58(2):259-263.
[6] 何强,沈晓刚.腹膜透析患者腹膜透析管的选择及置管方式的探讨[J].中国血液净化,2016,15(10):566-568.DOI:10.3969/j.issn.1671-4091.2016.10.013. He Q,Shen XG.Discussion about how to select peritoneal dialysis catheter and the methods of insertion[J].Chin J Blood Purif,2016,15(10):566-568.DOI:10.3969/j.issn.1671-4091.2016.10.013.
[7] Woodrow G,Fan SL,Reid C,et al.Renal association clinical practice guideline on peritoneal dialysis in adults and children[J].BMC Nephrol,2017,18(1):333.DOI:10.1186/s12882-017-0687-2.
[8] Liu YR,Zhang L,Lin AW,et al.Impact of break-in period on the short-term outcomes of patients started on peritoneal dialysis[J].Perit Dial Int,2014,34(1):49-56.DOI:10.3747/pdi.2012.00293.
[9] 陆良生,毕允力,阮双岁,等.儿童三种不同腹膜透析置管术式并发症分析[J].中华小儿外科杂志,2012,33(10):775-777.DOI:10.3760/cma.j.issn.0253-3006.2012.10.014. Lu LS,Bi YL,Ruan SS,et al.The complications of three different techniques of peritoneal dialysis catheters placement in children[J].Chin J Pediatr Surg,2012,33(10):775-777.DOI:10.3760/cma.j.issn.0253-3006.2012.10.014.
[10] Crabtree JH.SAGES guidelines for laparoscopic peritoneal dialysis access surgery[J].Surg Endosc,2014,28(11):3013-3015.DOI:10.1007/s00464-014-3812-3.
[11] Ya[KG-0.8mm]??z B,Karal? DT,Nal?ac?o?lu H,et al.Laparoscopic peritoneal dialysis catheter insertion with omentopexy-sparing the omentum in children[J].Pediatr Surg Int,2024,40(1):128.DOI:10.1007/s00383-024-05702-3.
[12] Ladd AP,Breckler FD,Novotny NM.Impact of primary omentectomy on longevity of peritoneal dialysis catheters in children[J].Am J Surg,2011,201(3):401-405.DOI:10.1016/j.amjsurg.2010.08.022.
[13] Moreiras Plaza M,Cuí?a L,Goyanes GR,et al.Mechanical complications in chronic peritoneal dialysis[J].Clin Nephrol,1999,52(2):124-130.
[14] 高阳旭,刘晓宇,钟旭辉,等.肾衰竭患儿腹膜透析管置入术及并发症临床分析[J].中国血液净化,2020,19(1):21-24.DOI:10.3969/j.issn.1671-4091.2020.01.006. Gao YX,Liu XY,Zhong XH,et al.Clinical analysis of peritoneal dialysis tube implantation and complications in children with renal failure[J].Chin J Blood Purif,2020,19(1):21-24.DOI:10.3969/j.issn.1671-4091.2020.01.006.
[15] Radtke J,Lemke A,Kemper MJ,et al.Surgical complications after peritoneal dialysis catheter implantation depend on children’s weight[J].J Pediatr Surg,2016,51(8):1317-1320.DOI:10.1016/j.jpedsurg.2015.12.005.
[16] Stone MM,Fonkalsrud EW,Salusky IB,et al.Surgical management of peritoneal dialysis catheters in children:five-year experience with 1,800 patient-month follow-up[J].J Pediatr Surg,1986,21(12):1177-1181.DOI:10.1016/0022-3468(86)90033-3.
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备注/Memo
收稿日期:2024-11-19。
基金项目:四川大学华西医院学科卓越发展1·3·5工程项目(2021HXFH020);四川大学华西医院“启明星”青年人才科研启动基金(HXQMX0070)
通讯作者:向波,Email:xb_scu.edu@hotmail.com