Experiment And Clinical Research Of Trocar For Placement Of Peritoneal Dialysis Catheter

BACKGROUNDContinuous ambulatory peritoneal dialysis (CAPD),is commonly used in uraemia patients, and the outcome highly depended on a well functional PD catheter.The placement of the catheter is frequently limited by the cooperation of a surgeon. Furthermore, videolaparoscopic has been reported to be a good method,but the inclusion price is too high.So,a less costly, safe and effective method is needed.We plan to evaluate the use a novel Trocar with less blade exposure in the abdominal cavity, and a unique self retaining stability sleeve for placement of peritoneal dialysis catheter.METHODSSection A1.A total of 28 Newzerland rabbits were randomly assigned to the following two groups:Trocar group(Trocar)and Tradition group(Trad);2.The time of operation and general state ofhealth were recorded;3.At the time of 1,3,5,7,9,11 and 14,Methylthioninium Chloride solution was injected into the abdominal cavity of two rabbits randomly selected from each group,and determinanting of intraperitoneal pressure(IPP).4.Identifying the location of peritoneal dialysis catheter,and impairmem of organs in abdominal cavity after cutting the belly open.Section B1.40 CRF patients were enrolled and randomly divided into Trocar group(n=20) and Traditon group(n=20); 2.The time of operation and out-of-bed activity were recorded;3.Observing complication of operation and catheter related.RESULTSection A1.The time of operation in Trocar group was remarkably shorter than in Trad group (P<0.001);2.Abdominal pain,impairmem of organs in abdominal cavity and haematoma were not observed in both two groups;3.IPP when weeping was stepping up following the extension of time in Trocar group(r =0.89,P<0.01). After seven day,weeping was not accured when the IPP was high than 20cmH20. Comparatively, weeping was not accured when the IPP was high than 20cmH20 after one day;4.Bloody ascites (n=1), adherence between cuff and caul (n=2), cuff and bowel (n=1) were happened in Trocar group.Abdominal membrane was suture with intestinal wall in one case in Trad group; 5.Peritoneum began to heal incompletely 24 hours afters surgery and the fi-broblast began to proliferate 2,3 days later. Complete healing of peritoneum occurred on the 7th day. There ware significally difference on the peritoneal healing and adhesion formation between the two groups (P<0.01).Section B1.The time of operation and out-of-bed activity in Trocar group was remarkably shorter than in Trad group (P