【摘要】目的探索并完善儿童腹膜透析管的置入方法，减少术后并发症，提高透析效益。方法回顾性分析2015 年1 月～2018 年12 月北京大学第一医院儿童外科行儿童腹膜透析管置入术病例，分析总结手术方法、效果及术后并发症。结果共51 例纳入本研究，依据置管术方式不同分为大网膜未切除组23 例、大网膜部分切除组28 例。未切网膜组采用经腹直肌内潜行置管手术方法，术后堵管5 例，堵管率21.74%(5/23)；大网膜部分切除组经腹直肌内潜行置管，并切除部分大网膜，术后无堵管病例，无二次手术病例，2 组比较存在统计学差异(χ2=6.749，P=0.009)。全部51 例患者无术后感染病例。结论经右侧腹直肌潜行置管并切除部分大网膜，术后并发症明显减低，减少患儿多次手术痛苦，利于腹膜透析治疗顺利进行。
【Abstract】Objective To improve the method of peritoneal dialysis catheterization in children in order to reduce the postoperative complications and to increase the efficiency of peritoneal dialysis (PD). Methods The children undergoing PD catheterization in the Department of Pediatric Surgery, Peking University First Hospital from January 2015 to December 2018 were retrospectively reviewed. Results A total of 51 cases were enrolled in this study. According to the method of catheterization, they were divided into unresected omentum group (n=23) and partial resected omentum group (n=28). In unresected omentum group, the catheter was inserted into abdominal cavity through a distance of abdominal wall in right rectus abdominis; postoperative occlusion of the tube was found in 5 cases (21.74%). In partial resected omentum group, the catheters were placed using the same method and the omentum was partially removed; no postoperative occlusion of the tube was found and no secondary operation was required. The difference in catheter occlusion was statistically significant between the two groups (χ2=6.749,P=0.009). No postoperative infection occurred in both groups. Conclusion The PD catheter inserted into abdominal cavity through a distance of abdominal wall in right rectus abdominis and partial removal of omentum can significantly reduce the postoperative complications and the requirement for secondary operation, facilitating the PD management in children.
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