腹腔鏡下ＣＡＰＤカテーテル留置術

DOI 被引用文献2件 参考文献9件

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  • Laparoscopic placement of the CAPD catheter.

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The technical success of CAPD depends upon correct positioning of the CAPD catheter. Various techniques including a blind technique or open laparotomy have been described for the placement of the catheter. However, these methods may be associated with high morbidity and early catheter complication. The present report describes a technique which enables the laparoscopic placement of the CAPD catheter with minilaparotomy (LPC).<br>Under general anesthesia, the patient was placed in the supine position. A φ10-mm cannula was placed in the paraumbilicus and a laparoscope was inserted through a trocar. A double purse-string suture was placed at the posterior rectus sheath and peritoneum after creation of a 3-cm long paramedian skin incision, and a CAPD catheter was introduced laparoscopically into the appropriate position in the pelvis with a stylet. After placement of the catheter, the stylet was removed and the purse-string suture was closed tightly under laparoscopic vision. A subcutaneous tunnel was created, and finally the paramedian wound and the φ10-mm cannula site were closed.<br>Nine patients underwent LPC and one patient underwent laparoscopic repositioning of a CAPD catheter with a stylet only without any cannula. All ten of the CAPD catheters were placed in the appropriate position in the pelvis. Dialysate leakage around the catheters did not occur in any patients. The patients were introduced to CAPD earlier and were freed from hemodialysis on POD 7.7 on average.<br>In conclusion, this technique enables the secure placement of the CAPD catheter in the desired position in the pelvis and allows early initiation of CAPD.

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