带直肌鞘隧道的腹腔镜腹膜透析导管放置：单孔简化技术

腹膜透析的成功取决于透析导管的正确放置和功能寿命。 通过直肌鞘隧道的腹腔镜植入导管可以最大限度地降低导管失败的风险。

本研究旨在描述单端口简化技术，用于腹腔镜放置带直肌鞘隧道的腹膜透析导管。

在 16 名慢性肾功能衰竭患者中进行了带直肌鞘隧道的 Tenckhoff 导管的简化腹腔镜插入。

随访期间未发生重大并发症。 三名患者被排除在外。 一名患者在植入数周后转诊接受肾移植，另一名患者在随访期间因其他原因死亡。 另一名患者由于之前的手术需要粘连松解术，因此需要一个额外的端口。 其余13根导管工作正常，未发生术后出血、早期渗漏、疝气、导管移位等情况。 一名患者在植入后 11 个月发生隧道感染。 随访期间未见腹膜炎。

该技术操作简单、重复性好、安全，导管功能效果好，并发症少，导管成活率高。 它不需要特殊设备或套管针，并避免过多的端口位置。

带直肌鞘隧道的腹腔镜腹膜透析导管放置：单孔简化技术

(A) 脐周切口； (B) 用套件的导丝插入 Veress 针的套管； (C) Veress 针在腹膜前空间尾部前进至少 6 厘米； (D) 针头进入腹膜； (E) 导丝进入空腔； (F)带座扩张器经隧道引入； (G) 放置在道格拉斯陷凹中的导管； (H) 腹膜前隧道可见。

1. Attaluri V, Lebeis C, Brethauer S, Rosenblatt S. Advanced laparoscopic techniques significantly improve function of peritoneal dialysis catheters. J Am Coll Surg. 2010;211(6):699–704. doi: 10.1016/j.jamcollsurg.2010.08.010.   
2. Bar-Zohar D, Sagie B, Lubezky N, Blum M, Klausner J, Abu-Abeid S. Laparoscopic implantation of the Tenckhoff catheter for the treatment of end-stage renal failure and congestive heart failure: experience with the pelvic fixation technique. Isr Med Assoc J. 2006;8(3):174–178.  
3. Bircan HY, Kulah E. Effects of a novel peritoneal dialysis: the open versus laparoscopic preperitoneal tunneling technique. Ther Apher Dial. 2016;20(1):66–72. doi: 10.1111/1744-9987.12377.   
4. Chula DC, Campos RP, Alcantara MT, Riella MC, Nascimento MM. Percutaneous and surgical insertion of peritoneal catheter in patients starting in chronic dialysis therapy: a comparative study. Semin Dial. 2014 May-Jun;27(3):E32–E37. doi: 10.1111/sdi.12147.   
5. Coelho JCU, Dalledone GO, Schiel W, Berbardin JP, Claus CMP, Matias JEF, et al. Does male gender increase the risk of laparoscopic cholecystectomy? ABCD Arq Bras Cir Dig. 2019;32(2):e1438. doi: 10.1590/0102-672020190001e1438.   
6. Comert M, Borazan A, Kulah E, Uçan BH. A new laparoscopic technique for the placement of a permanent peritoneal dialysis catheter: the preperitoneal tunneling method. Surg Endosc. 2005;19(2):245–248. doi: 10.1007/s00464-003-9302-7.   
7. Crabtree JH. SAGES guidelines for laparoscopic peritoneal dialysis access surgery. Surg Endosc. 2014;28(11):3013–3015. doi: 10.1007/s00464-014-3812-3.   
8. Crabtree JH. Selected best demonstrated practices in peritoneal dialysis access. Kidney Int Suppl. 2006;(103):S27–S37. doi: 10.1038/sj.ki.5001913.   
9. Crabtree JH, Burchette RJ. Effective use of laparoscopy for long-term peritoneal dialysis access. Am J Surg. 2009;198(1):135–141. doi: 10.1016/j.amjsurg.2008.10.019.   
10. Crabtree JH, Fishman A. A laparoscopic method for optimal peritoneal dialysis access. Am Surg. 2005;71(2):135–143. doi: 10.1177/000313480507100209.   
11. Crabtree JH, Shrestha BM, Chow KM, Figueiredo AE, Povlsen JV, Wilkie M, et al. Creating and maintaining optimal peritoneal dialysis access in the adult patient: 2019 update. Perit Dial Int. 2019;39(5):414–436. doi: 10.3747/pdi.2018.00232.   
12. Frost JH, Bagul A. A brief recap of tips and surgical manoeuvres to enhance optimal outcome of surgically placed peritoneal dialysis catheters. Int J Nephrol. 2012;2012:251584–251584. doi: 10.1155/2012/251584.   
13. Gultekin FA, Cakmak GK, Karakaya K, Emre AU, Tascilar O, Oner MO, et al. Our long-term results of Tenckhoff peritoneal dialysis catheters placement via laparoscopic preperitoneal tunneling technique. Semin Dial. 2013;26(3):349–354. doi: 10.1111/sdi.12003.   
14. Gunes ME, Uzum G, Koc O, Duzkoylu Y, Kucukyilmaz M, Sari YS, et al. A modified method in laparoscopic peritoneal catheter implantation: the combination of preperitoneal tunneling and pelvic fixation. ISRN Surg. 2013;2013:248126–248126. doi: 10.1155/2013/248126.   
15. Haggerty S, Roth S, Walsh D, Stefanidis D, Price R, Fanelli RD, et al. Guidelines for laparoscopic peritoneal dialysis access surgery. Surg Endosc. 2014;28(11):3016–3045. doi: 10.1007/s00464-014-3851-9.   
16. Harissis HV, Katsios CS, Koliousi EL, Ikonomou MG, Siamopoulos KC, Fatouros M, et al. A new simplified one port laparoscopic technique of peritoneal dialysis catheter placement with intra-abdominal fixation. Am J Surg. 2006;192(1):125–129. doi: 10.1016/j.amjsurg.2006.01.033.   
17. Juergensen E, Wuerth D, Finkelstein SH, Juergensen PH, Bekui A, Finkelstein FO. Hemodialysis and peritoneal dialysis: patients’ assessment of their satisfaction with therapy and the impact of the therapy on their lives. Clin J Am Soc Nephrol. 2006;1(6):1191–1196. doi: 10.2215/CJN.01220406.   
18. Keshvari A, Keramati MR, Nassajian MR, Mohsenipour M, Nouritaromlou MK. Introduction of a new laparoscopic trocar for insertion of peritoneal dialysis catheters and making a proper rectus sheath tunneling. Surg Endosc. 2016;30(12):5325–5329. doi: 10.1007/s00464-016-4883-0.   
19. Keshvari A, Najafi I, Jafari-Javid M, Yunesian M, Chaman R, Taromlou MN. Laparoscopic peritoneal dialysis catheter implantation using a Tenckhoff trocar under local anesthesia with nitrous oxide gas insufflation. Am J Surg. 2009;197(1):8–13. doi: 10.1016/j.amjsurg.2007.10.022.   
20. Krezalek MA, Bonamici N, Kuchta K, Lapin B, Carbray J, Denham W, et al. Peritoneal dialysis catheter function and survival are not adversely affected by obesity regardless of the operative technique used. Surg Endosc. 2018;32(4):1714–1723. doi: 10.1007/s00464-017-5852-y.   
21. Lu CT, Watson DI, Elias TJ, Faull RJ, Clarkson AR, Bannister KM. Laparoscopic placement of peritoneal dialysis catheters: 7 years experience. ANZ J Surg. 2003;73(3):109–111. doi: 10.1046/j.1445-2197.2003.02651.x.   
22. Ogunc G. Minilaparoscopic extraperitoneal tunneling with omentopexy: a new technique for CAPD catheter placement. Perit Dial Int. 2005;25(6):551–555.  
23. Ramos MFKP, Pereira MA, Dias AR, Castria TB, Sakamoto E, Ribeiro-Jr U, et al. Surgical treatment in clinical stage iv gastric cancer: a comparison of different procedures and survival outcomes. ABCD Arq Bras Cir Dig. 2022;35:e1648. doi: 10.1590/0102-672020210002e1648.   
24. Riella MC, Chula DC. Peritoneal dialysis access: what’s the best approach? Contrib Nephrol. 2012;178:221–227. doi: 10.1159/000337882.   
25. Sabbag C, Blitzckow A. Alternative technique for cholecystectomy comparable to single port. ABCD Arq Bras Cir Dig. 2017;30(1):53–55. doi: 10.1590/0102-6720201700010015.   
26. Shrestha BM, Shrestha D, Kumar A, Shrestha A, Boyes SA, Wilkie ME. Advanced laparoscopic peritoneal dialysis catheter insertion: systematic review and meta-analysis. Perit Dial Int. 2018;38(3):163–171. doi: 10.3747/pdi.2017.00230.   
27. Tenckhoff H, Curtis FK. Experience with maintenance peritoneal dialysis in the home. Trans Am Soc Artif Intern Organs. 1970;16:90–95.