不同腹膜透析置管相关技术对患者预后影响的 Meta 分析.

OBJECTIVE: For peritoneal dialysis patients, the more therapeutic way of insertion catheterization techniques is controversial. There is no evidence of highgrade evidence-based medicine. This study systemically assessed influence of different insertion catheterization techniques on the prognosis of peritoneal dialysis patients, and reviewed the clinical value of percutaneous insertion catheterization in peritoneal dialysis. METHODS: The PubMed, EMbase, the Cochrane Library, CNKI, VIP, and Wanfang databases of cohort study literature on the comparison of percutaneous technique and surgical incision technique for peritoneal dialysis catheterization published from inception to October 30, 2019 were searched by computer. The effective data were selected and the Newcastle-Ottawa Scale was used to evaluate the quality. Primary outcomes were infection complications, mechanical complications, 1-year peritoneal dialysis tube survival rate, and extubation rate caused by complications. The odds ratio (OR) was the effect indicator. Metaanalysis was performed using RevMan 5.3 software. RESULTS: (1) A total of 12 studies were included, including 2 prospective cohort studies and 10 retrospective cohort studies. A total of 2 203 patients were enrolled, including 1 164 patients in the percutaneous puncture group and 1 039 patients in the peritoneal incision group. (2) The incidence of infection complications, the incidence of mechanical complications, and the 1-year catheter survival rate were not statistically significant between the percutaneous puncture group and the peritoneal incision group (OR=0.57, 95%CI:0.31-1.04, P=0.07: OR=0.88, 95%CI:0.77-1.09, P=0.25; OR=1.05, 95%CI:0.68-1.64, P=0.81). (3) The extubation rate caused by complications in the percutaneous puncture group was lower than in the peritoneal incision group (OR=0.59, 95%CI:0.47- 0.74, P < 0.000 1). (4) Subgroup analysis results of cases of infection complications group and 1-year catheter survival rate group according to the type of study suggested that heterogeneity mainly came from retrospective study subgroups, and the meta-analysis results in each subgroup showed there was no significant difference between the two groups. (5) Funnel diagram analysis results showed mild publication bias in dialysis tube infection complications and 1-year survival rate of the included articles. CONCLUSION: It is safe and effective to apply the peritoneal dialysis catheterization with a percutaneous insertion technique, and its clinical effects and prognosis are similar with the traditional open surgical technique. The percutaneous insertion technique could be an ideal alternative to the traditional one. [ABSTRACT FROM AUTHOR]