三种改良经皮穿刺置管术在儿童腹膜透析中的应用与比较：基于单中心8年回顾性研究

doi:10.12372/jcp.2026.25e1432

Abstract

Abstract:

Objective To evaluate the efficacy and safety of modified percutaneous peritoneal dialysis (PD) catheterization techniques in pediatric uremic patients, and to compare the clinical advantages and limitations of three distinct modified approaches. Methods A single-center retrospective cohort study was conducted, enrolling pediatric patients who underwent their first percutaneous PD catheterization for uremia at the department of nephrology between January 1, 2017 and December 31, 2024. Patients were stratified into three groups based on the catheterization technique: Group A (puncture cannula combined with rigid guidewire-guided technique), Group B (peel-away sheath combined with rigid guidewire-guided technique), and Group C (pneumoperitoneum-assisted trocar combined with rigid guidewire-guided technique). Baseline characteristics, procedural duration, incidence of intraoperative incision bleeding, time to initiation of dialysis, and incidences of catheter dysfunction and PD-related infections within 1 year of regular PD initiation were collected and analyzed statistically. Results A total of 98 patients were included, with well-balanced baseline characteristics across groups. All patients received regular PD for≥1 month; 75 completed≥6 months of PD, and 53 completed≥12 months. Procedural duration differed significantly among the three groups (P<0.05), with Group C having the shortest duration (significantly shorter than Group A, P<0.01). Cross-sectional analyses at postoperative time points revealed no significant differences in incision bleeding, time to dialysis initiation, poor drainage, leakage, or PD-related infections (P>0.05). Kaplan-Meier survival analysis showed 1-year catheter survival rates of 0.89, 0.79, and 0.96 in Groups A, B, and C, respectively. However, Cox proportional hazards regression demonstrated no significant difference in 1-year catheter survival among the three techniques. Further survival analyses for key catheter-related adverse events showed no significant intergroup differences in 1-year tunnel infection or peritonitis rates. Notably, Group C had a significantly higher incidence of poor drainage than Group A (P=0.034). Conclusion Modified percutaneous PD catheterization is a safe, effective, and technically feasible approach suitable for dissemination among pediatric nephrologists. The peel-away sheath combined with rigid guidewire technique exhibits the most balanced performance in terms of procedural efficiency and complication control. While the pneumoperitoneum-assisted trocar technique significantly shortens procedural duration, it may increase the risk of postoperative poor drainage, warranting selective application in centers with proficient technical expertise.

Key words: percutaneous, peritoneal dialysis catheter placement, uremia, child

CLC Number:

CHEN Qiuxia, ZHU Chunhua, ZHAO Fei, WU Hongmei, ZHANG Aihua. Application and comparison of three modified percutaneous catheterization techniques in pediatric peritoneal dialysis: an 8-year retrospective single-center study[J].Journal of Clinical Pediatrics, 2026, 44(4): 314-322.

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References 26

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观察指标	A组（n=33）	B组（n=25）	C组（n=40）	统计量	P
男性[n(%)]	19（57.58）	12（48.00）	20（50.00）	χ²=0.64	0.728
年龄[M(P₂₅~P₇₅)]/a	11.17(8.59~13.75)	11.50(3.88~13.13)	12.04(10.29~13.71)	H=3.10	0.213
体重[M(P₂₅~P₇₅)]/kg	26.50(21.50~34.00)	25.60(14.45~32.35)	29.85(24.93~39.38)	H=6.00	0.051
BMI($\bar{x}±s$)	15.40±2.82	15.67±2.03	15.86±2.72	F=0.29	0.748
手术时长($\bar{x}±s$)/min	53.33±15.39	45.80±13.74	43.43±15.68	F=4.07	0.020
术口渗血[n(%)]	2（6.06）	3（12.00）	6（15.00）	χ²=1.47	0.479
开始腹透间期($\bar{x}±s$)/d	11.00±9.33	12.00±5.34	14.88±5.99	F=2.88	0.061
隧道口感染[n(%)]	2（6.06）	7（28.00）	7（17.50）	χ²=5.08	0.079
腹膜炎[n(%)]	1（3.03）	2（8.00）	2（5.00）	χ²=0.73	0.695
引流不畅[n(%)]	6（18.18）	5（20.00）	16（40.00）	χ²=5.27	0.072
渗漏[n(%)]	1（3.03）	0（0）	1（2.50）	χ²=0.73	0.696

观察指标	A组（n=28）	B组（n=19）	C组（n=28）	统计量	P
男性[n(%)]	18（64.29）	9（47.37）	11（39.29）	χ²=3.61	0.164
年龄($\bar{x}±s$)/a	10.77±3.57	11.11±4.97	11.60±3.10	F=0.33	0.717
体重($\bar{x}±s$)/kg	26.96±8.41	27.33±9.62	30.95±11.96	F=1.26	0.290
BMI($\bar{x}±s$)	14.95±1.48	16.08±2.14	15.71±2.16	F=2.19	0.119
手术时长($\bar{x}±s$)/min	54.64±15.87	45.79±14.84	42.68±11.10	F=5.42	0.006
术口渗血[n(%)]	2（7.14）	1（5.26）	5（17.86）	χ²=2.47	0.291
开始腹透间期($\bar{x}±s$)/d	11.43±10.06	12.63±5.52	15.46±6.68	F=1.90	0.156
隧道口感染[n(%)]	5（17.86）	5（26.32）	3（10.71）	χ²=5.15	0.272
腹膜炎[n(%)]	1（3.57）	3（15.79）	6（21.43）	χ²=7.25	0.123
引流不畅[n(%)]	2（7.14）	5（26.32）	5（17.86）	χ²=5.03	0.284
渗漏[n(%)]	0（0）	3（15.79）	2（7.14）	χ²=7.53	0.110

观察指标	A组（n=23）	B组（n=11）	C组（n=19）	统计量	P
男性[n(%)]	17（73.91）	6（54.55）	9（47.37）	χ²=3.28	0.211
年龄($\bar{x}±s$)/a	10.34±3.42	10.69±4.02	11.42±3.65	F=0.47	0.628
体重($\bar{x}±s$)/kg	26.10±8.18	27.80±9.66	28.33±11.05	F=0.30	0.740
BMI($\bar{x}±s$)	14.86±1.60	16.28±2.34	15.53±2.07	F=2.06	0.138
手术时长($\bar{x}±s$)/min	56.74±16.07	45±16.88	40.26±9.79	F=7.28	0.002
术口渗血[n(%)]	2（8.70）	0（0）	4（21.05）	χ²=2.72	0.278
开始腹透间期($\bar{x}±s$)/d	12.04±10.83	12.46±1.92	15.79±8.12	F=1.05	0.356
隧道口感染[n(%)]	3（13.04）	0（0）	2（10.53）	χ²=2.46	0.790
腹膜炎[n(%)]	2（8.70）	2（18.18）	3（15.79）	χ²=3.59	0.466
引流不畅[n(%)]	1（4.35）	1（9.09）	1（5.26）	χ²=0.84	1.000
渗漏[n(%)]	2（8.70）	0（0）	0（0）	χ²=1.84	0.683

Application and comparison of three modified percutaneous catheterization techniques in pediatric peritoneal dialysis: an 8-year retrospective single-center study

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