郑婕　　李小生　　彭凤　　叶菁

[摘要] 目的 探讨腹腔镜与开腹腹膜透析置管术对机体炎症反应的影响。 方法 选取2018年10月至2019年1月于我院行腹膜透析的60例尿毒症患者，其中30例行腹腔镜下腹膜透析置管手术的设为腹腔镜组，30例行开腹腹膜透析置管手术的设为开腹组。比较两组术中、术后情况和机体炎症反应、并发症发生情况。 结果 腹腔镜组术中出血量、疼痛程度、术后3 d降钙素原（PCT）、C反应蛋白（CRP）、癌抗原125（CA125）、白细胞（WBC）计数和引流不畅、导管移位、腹膜炎发生率低于开腹组，肠道功能恢复时间长于开腹组，手术时间短于开腹组，差异有统计学意义（P<0.05）;两组住院时间比较，差异无统计学意义（P>0.05）。 结论 尿毒症患者行腹腔镜腹膜透析置管术具有创伤小、失血量少、疼痛轻微、炎症反应轻、并发症少等优点，值得临床推广。

[关键词] 尿毒症;腹膜透析置管术;腹腔镜;炎症反应;疼痛程度;并发症

[中图分类号] R735.2          [文献标识码] A          [文章编号] 1673-9701（2021）11-0017-04

Clinical study on the effect of laparoscopic and open peritoneal dialysis catheterization on inflammatory response

ZHENG Jie1   LI Xiaosheng1   PENG Feng1   YE Jing2

1.The First Affiliated Hospital of Gannan Medical University， Ganzhou   341000， China; 2.Jiangxi University of Traditional Chinese Medicine， Nanchang   330004， China

[Abstract] Objective To explore the influence of laparoscopic and open peritoneal dialysis catheterization on inflammation. Methods Sixty uremic patients who underwent peritoneal dialysis in our hospital from October 2018 to January 2019 were selected. 30 cases of laparoscopic peritoneal dialysis catheter were set as the laparoscopic group， and 30 cases of open peritoneal dialysis catheter were set as the laparotomy group. The intraoperative and postoperative conditions， inflammatory reaction and complications of the two groups were compared. Results The bleeding volume， pain degree， procalcitonin（PCT）， C-reactive protein （CRP）， cancer antigen 125（CA125）， white blood cell （WBC） count and poor drainage， catheter displacement and peritonitis in laparoscopic group were lower than those in laparotomy group. The recovery time of intestinal function was longer， and the operation time was shorter than that of laparotomy group， with statistically significant difference （P<0.05）. There was no significant difference in hospital stay between the two groups （P>0.05）. Conclusion Laparoscopic peritoneal dialysis catheterization has the advantages of less trauma， less blood loss， less pain， less inflammatory reaction and fewer complications for uremic patients， which is worthy of clinical promotion.

[Key words] Uremia; Peritoneal dialysis catheterization; Laparoscopy; Inflammatory reaction; Degree of pain; Complication

腹膜透析是終末期肾脏病的主要治疗手段，操作简单且对血液动力学影响小，可保护残存肾功能，减少血源性疾病传播[1-2]。腹膜透析导管位置良好与通畅是腹膜透析成功的关键，开腹与腹腔镜腹膜透析置管术是常用的置管方式，前者能在直视下操作，操作简单，解剖层次清晰，出血与肠穿孔风险较小，后者全程可视，术野范围更加全面，能将导管在直视下置入子宫直肠窝或膀胱直肠窝并固定[3-5]。本文回顾性分析2018年10月至2019年1月在我院行腹膜透析的60例尿毒症患者临床资料，分析腹腔镜与开腹腹膜透析置管术对机体炎症反应的影响，为临床治疗提供参考依据，现报道如下。……