[1]郭晖,张亚伟,郭祥,等.儿童腹腔镜下腹膜透析管内固定的临床价值及对早期启动透析的安全性影响[J].临床小儿外科杂志,2026,(02):165-168.[doi:10.3760/cma.j.cn101785-202506037]
　Guo Hui,Zhang Yawei,Guo Xiang,et al.Clinical value and safety of laparoscopic intraperitoneal fixation of peritoneal dialysis catheters for early initiation of dialysis in children[J].Journal of Clinical Pediatric Surgery,2026,(02):165-168.[doi:10.3760/cma.j.cn101785-202506037]
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儿童腹腔镜下腹膜透析管内固定的临床价值及对早期启动透析的安全性影响

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 期数: 2026年02 页码: 165-168 栏目: 论著 出版日期: 2026-02-28
Title:
Clinical value and safety of laparoscopic intraperitoneal fixation of peritoneal dialysis catheters for early initiation of dialysis in children
作者:
郭晖;  张亚伟;  郭祥;  王军;  马慧;  程银涛;  陈海涛
华中科技大学同济医学院附属武汉儿童医院泌尿外科, 武汉 430016
Author(s):
Guo Hui;  Zhang Yawei;  Guo Xiang;  Wang Jun;  Ma Hui;  Cheng Yintao;  Chen Haitao
Department of Urology, Wuhan Children’s Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430016, China
关键词:
腹膜透析; 导管; 留置; 腹腔镜; 病人安全; 儿童
Keywords:
Peritoneal Dialysis; Catheters;  Indwelling; Laparoscopes; Patient Safety; Child
DOI:
10.3760/cma.j.cn101785-202506037
摘要:
目的 探讨儿童腹腔镜下腹膜透析管(以下简称腹透管)置入术中行腹膜透析管内固定的临床价值,并评估该技术对患儿早期启动透析的安全性影响。方法 本研究为回顾性队列研究,以华中科技大学同济医学院附属武汉儿童医院泌尿外科收治的57例行腹腔镜下腹膜透析管置入术的患儿为研究对象,根据手术方式分为两组:固定组30例,术中行腹透管内固定并显露至少一个侧孔;非固定组27例,采用常规腹腔镜置管,未行内固定及刻意显露侧孔。所有患儿门诊随访3个月至4年,比较两组手术相关指标、术后并发症发生情况及透析效果。结果 两组患儿年龄、手术时长、术中出血量及术后首次透析时间比较,差异均无统计学意义(P＞0.05)。固定组与非固定组患儿总体并发症发生率(10.0%比44.4%)和非计划拔管率(3.3%比25.9%)差异具有统计学意义(P＜0.05)。患儿术后首次透析时间均短于2周,其中固定组5例于术后72 h内启用透析,且均未发生导管相关感染及腹膜炎,但有1例发生导管堵塞、1例发生透析液渗漏。置管后3个月内,固定组在腹透管阻塞(6.7%比29.6%)、导管移位发生率(0比18.5%)方面显著低于非固定组,差异具有统计学意义(P＜0.05)。对50例置管时间超过3个月患儿的分析结果显示,此阶段固定组在腹透管堵塞、导管相关感染及腹膜炎发生率方面亦低于非固定组,差异具有统计学意义(P＜0.05)。结论 儿童腹腔镜腹透管置入术中采用腹透管内固定并显露侧孔的技术优势显著,能有效减少术后早期及远期的导管相关并发症,可使患儿安全、有效地早期启用透析。
Abstract:
Objective To explore the clinical value of intraperitoneal fixation of peritoneal dialysis (PD) catheters during laparoscopic PD catheter insertion in children,and to evaluate the impact of this technique on the safety of early initiation of dialysis in pediatric patients. Methods This was a retrospective cohort study including 57 children who underwent laparoscopic peritoneal dialysis catheter insertion at Wuhan Children’s Hospital.According to the surgical technique,patients were divided into two groups:the fixation group (n=30),in which intraperitoneal fixation of the peritoneal dialysis catheter was performed intraoperatively with exposure of at least one side hole; and the non-fixation group (n=27),in which conventional laparoscopic catheter insertion was performed without intraperitoneal fixation or deliberate exposure of side holes.All patients were followed up in the outpatient clinic for 3 months to 4 years.Surgical-related indicators,postoperative complications,and dialysis outcomes were compared between the two groups. Results There were no statistically significant differences between the two groups in age,operative time,intraoperative blood loss,or time to first postoperative dialysis (P>0.05).Significant differences were observed between the two groups in overall complication rates and unplanned catheter removal rates (P<0.05).The time to first postoperative dialysis in all patients was less than 2 weeks.In the fixation group,5 patients initiated dialysis within 72 hours after surgery,and none developed catheter-related infection or peritonitis; however,one patient experienced catheter obstruction,and one patient experienced dialysate leakage.Within 3 months after catheter insertion,the incidence of peritoneal dialysis catheter obstruction and catheter migration in the fixation group was significantly lower than that in the non-fixation group (P<0.05).Analysis of 50 patients with catheter duration longer than 3 months showed that,during this period,the fixation group also had significantly lower incidences of catheter obstruction,catheter-related infection,and peritonitis compared with the non-fixation group (P<0.05). Conclusions During laparoscopic peritoneal dialysis catheter insertion in children,the technique of intraperitoneal catheter fixation with exposure of side holes has significant advantages.It can effectively reduce early and late postoperative catheter-related complications and allows safe and effective early initiation of dialysis in pediatric patients.

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备注/Memo

收稿日期:2025-6-16。
通讯作者:张亚伟,Email:915713142@qq.com

更新日期/Last Update: 1900-01-01