Comparison Of Clinical Efficacy Of Peritoneal Dialysis Catheter Implantation By Laparoscopy And Anatomy

Objective:In this study,we reviewed the clinical data of patients with peritoneal dialysis（PD）and compared the complications and long-term prognosis of laparoscopic catheter implantation and anatomic catheter implantation.This study aims to explore which catheterization method is more suitable for PD patients and provide reference for clinicians to formulate surgical plans.Methods:We recruited all PD patients at the Second Hospital of Jilin University between January 1,2011 and December 31,2021.The enrolled patients were divided into the laparoscopic catheter placement group and the anatomical catheter placement group according to the different catheterization methods.According to the PD catheterization time,the laparoscopic catheter placement group and the anatomical catheter placement group were matched 1:5.The difference in catheter placement time between matched patients was no more than 2 years.The impact of different catheterization methods on PD patients was investigated by comparing the basic clinical data,complications and technical survival rates of the two groups.Results:1.General data: The dialysis interval in the laparoscopic catheter placement group was longer than that in the anatomical catheter placement group（P=0.000）.There were no significant differences in gender,age,combined temporary HD,history of previous abdominal surgery,primary disease and complications between the two groups（P>0.05）.2.Laboratory indicators: Compared with anatomic catheter placement group,the laparoscopic catheter placement group has higher hemoglobin（P=0.004）,lower high-density lipoprotein（P=0.005）,lower serum potassium（P=0.002）and lower blood glucose（P=0.031）;however,there were no significant between-group differences in the other measured parameters（P>0.05）.3.Mechanical complications: The incidence of catheter migration at 3 months was obviously lower in the laparoscopic catheter placement group than in the anatomical catheter placement group（P=0.046）,and there was no significant difference between the two groups in the incidence of catheter migration at 2 weeks and 1 month（P>0.05）.The two groups showed comparable rates of other mechanical complications at 2 weeks,1 month and 3 months between groups（P>0.05）.4.Infection complications: The two groups showed comparable rates of infectious complications at 2 weeks,1 month and 3 months between groups（P>0.05）.5.Influence of different catheterization methods on mechanical complications and infectious complications: the results of Multivariate Logistic Regression model showed that catheterization methods were not independent risk factors affecting the occurrence of mechanical complications and infectious complications in PD patients at 2 weeks,1 month and 3 months.6.Technical survival rate: Kaplan-Meier survival curve analysis showed that the1-year,2-year and 3-year technical survival rates in the laparoscopic catheter placement group were 88.6%,79.8% and 79.8%,respectively,while the 1-year,2-year and 3-year technical survival rates in the anatomical catheter placement group were94.1%,90.4% and 86.9%,respectively.There was no between-group difference in technique survival rate（Log Rank=1.429 P=0.232）.Conclusion:1.Laparoscopic catheter implantation reduced catheter migration by 3 months.Different catheterization methods had no effect on other mechanical complications（leakage,bleeding,blockage,omental wrap）and infection complications.2.The type of catheterization is not a risk factor for the occurrence of infectious complications and mechanical complications.3.There was no significant difference in technical survival rate between different catheterization methods.