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首页> 外文期刊>Peritoneal dialysis international: Journal of the International Society for Peritoneal Dialysis >Omental folding: a novel laparoscopic technique for salvaging peritoneal dialysis catheters.
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Omental folding: a novel laparoscopic technique for salvaging peritoneal dialysis catheters.

机译：大网膜折叠：一种新的腹腔镜技术，用于挽救腹膜透析导管。

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摘要

BACKGROUND: Omental wrap is a common cause of catheter obstruction. Current laparoscopic techniques for correcting obstruction include omentopexy and omentectomy. This study evaluates the efficacy of a new laparoscopic technique for revision of obstructed peritoneal dialysis catheters. METHODS: Between November 2005 and November 2006, the technique was applied in 18 patients (6 female, 12 male; median age 50 years, range 16 - 73 years) on continuous ambulatory peritoneal dialysis with catheter malfunction secondary to omental wrap. Pneumoperitoneum was induced under general anesthesia. Three ports were inserted. The catheter was released from the omentum and repositioned in the pelvis. The omentum was then folded onto itself in a cephalad direction using silk sutures. This shortened the omentum. The risk of catheter migration was minimized with a polypropylene sling passed through the abdominal wall and around the catheter, then knotted subcutaneously. The sling allowed catheter removal without a new laparoscopy. The outcomes were prospectively evaluated. RESULTS: Median operating time was 90 minutes (range 35 - 160 minutes). Adhesiolysis was performed in 4 patients: 1 patient had port-site leakage of dialysate, which settled with abdominal rest; 1 patient had bleeding during adhesiolysis and laparoscopic hemostasis was successful; 1 patient had recurrent catheter obstruction 2 weeks post-operatively and was converted to hemodialysis; and 1 patient had recurrent malfunction secondary to small bowel wrap after 5.5 months; re-salvage was successful. The success rate of the first salvage procedure was 89%(16/18). The catheters were still functioning after a mean follow-up of 16.5 +/- 6.3 months (range 0.5 - 24 months). The 1-year catheter survival rate was 83.3%. CONCLUSIONS: Omental folding is a safe and effective technique for salvaging peritoneal dialysis catheters.
机译：背景：网膜包裹是导管阻塞的常见原因。当前用于矫正阻塞的腹腔镜技术包括网膜穿刺术和网膜切除术。这项研究评估了新的腹腔镜技术对阻塞性腹膜透析导管的修订的有效性。方法：自2005年11月至2006年11月，该技术被用于18例持续性非卧床腹膜透析并伴有网膜包裹的导管功能不全的患者（中位年龄50岁，范围16-73岁）。在全身麻醉下诱发气腹。插入了三个端口。将导管从网膜中释放出来，并重新放置在骨盆中。然后用丝线缝线将大网膜朝头折叠。这缩短了大网膜。聚丙烯吊索穿过腹壁并围绕导管，然后皮下打结，可将导管迁移的风险降至最低。吊索无需进行新的腹腔镜检查即可取出导管。对结果进行前瞻性评估。结果：中位手术时间为90分钟（范围35-160分钟）。 4例患者进行了粘膜溶解：1例患者出现透析液的端口位渗漏，并通过腹部休息得到了缓解。 1例患者在粘连期间出血，腹腔镜止血成功。 1例患者术后2周复发性导管阻塞，转为血液透析; 5.5个月后，有1例患者因小肠包裹而复发复发。重新抢救成功。首次抢救程序的成功率为89％（16/18）。平均随访16.5 +/- 6.3个月（范围0.5-24个月）后，导管仍在起作用。 1年导管生存率为83.3％。结论：网膜折叠术是挽救腹膜透析导管的一种安全有效的技术。

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