2023+SAGES指南:腹膜透析通路(更新版).pdf
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1、Vol.:(0123456789)1 3Surgical Endoscopy https:/doi.org/10.1007/s00464-023-10550-8SAGES/EAES OFFICIAL PUBLICATIONSAGES peritoneal dialysis access guideline update 2023StephenP.Haggerty1 SunjayS.Kumar2 AmeliaT.Collings3 VamsiV.Alli4 EmilyMiraflor5 NaderM.Hanna6 DimitriosI.Athanasiadis7 DavidJ.Morrell8
2、MohammedT.Ansari9 AhmedAbouSetta10 DanielleWalsh11 DimitriosStefanidis7 BethanyJ.Slater12Received:8 September 2023/Accepted:17 October 2023 The Author(s),under exclusive licence to Springer Science+Business Media,LLC,part of Springer Nature 2023AbstractBackground Minimally invasive surgery has been
3、used for both de novo insertion and salvage of peritoneal dialysis(PD)catheters.Advanced laparoscopic,basic laparoscopic,open,and image-guided techniques have evolved as the most popular techniques.The aim of this guideline was to develop evidence-based guidelines that support surgeons,patients,and
4、other physicians in decisions on minimally invasive peritoneal dialysis access and the salvage of malfunctioning catheters in both adults and children.Methods A guidelines committee panel of the Society of American Gastrointestinal and Endoscopic Surgeons reviewed the literature since the prior guid
5、eline was published in 2014 and developed seven key questions in adults and four in children.After a systematic review of the literature,by the panel,evidence-based recommendations were formulated using the Grad-ing of Recommendations Assessment,Development and Evaluation approach.Recommendations fo
6、r future research were also proposed.Results After systematic review,data extraction,and evidence to decision meetings,the panel agreed on twelve recommen-dations for the peri-operative performance of laparoscopic peritoneal dialysis access surgery and management of catheter dysfunction.Conclusions
7、In the adult population,conditional recommendations were made in favor of:staged hernia repair followed by PD catheter insertion over simultaneous and traditional start over urgent start of PD when medically possible.Furthermore,the panel suggested advanced laparoscopic insertion techniques rather t
8、han basic laparoscopic techniques or open insertion.Conditional recommendations were made for either advanced laparoscopic or image-guided percutaneous insertion and for either nonoperative or operative salvage.A recommendation could not be made regarding concomitant clean-contaminated surgery in ad
9、ults.In the pediatric population,conditional recommendations were made for either traditional or urgent start of PD,concomitant clean or clean-contaminated surgery and PD catheter placement rather than staged,and advanced lapa-roscopic placement rather than basic or open insertion.Keywords Chronic r
10、enal failure Guidelines Laparoscopic peritoneal dialysis catheter insertion Pediatrics Peritoneal dialysis accessAbbreviationsAL Advanced laparoscopic techniqueBL Basic laparoscopic techniqueCAPD Continuous ambulatory peritoneal dialysisCI Confidence intervalCKD Chronic kidney diseaseESRD End stage
11、renal diseaseEtD Evidence to decisionGRADE Grading of Recommendations,Assessment,Development,and EvaluationHD HemodialysisHPD Concomitant hernia repair and peritoneal dialy-sis accessIR Interventional radiologyISPD International Society for Peritoneal DialysisKQ Key questionOR Odds ratioPD Peritonea
12、l dialysisPICO Population,intervention,comparator,outcomeRCT Randomized controlled trialRRT Renal replacement therapyand Other Interventional Techniques Extended author information available on the last page of the article Surgical Endoscopy1 3RIGHT Essential Reporting Items for Practice Guide-lines
13、 in HealthcareSAGES The Society of American Gastrointestinal and Endoscopic SurgeonsUS United States of AmericaExecutive summaryBackgroundContinuous ambulatory peritoneal dialysis(CAPD)has become a widespread mode of renal replacement therapy(RRT)for patients with chronic renal failure.The surgeons
14、role in caring for these patients is to provide access to the peritoneal cavity via a peritoneal dialysis(PD)catheter and to diagnose and manage catheter complications.Since the early 1990s many surgeons have utilized laparoscopy for insertion of PD catheters as well as salvage of malfunction-ing ca
15、theters.In 2014,the Society for American Gastro-intestinal and Endoscopic Surgeons(SAGES)published clinical practice guidelines for laparoscopic peritoneal dial-ysis access surgery 1.Topics included:Indications and contraindications,insertion options,advanced laparoscopic techniques to avoid cathete
16、r dysfunction,peri-operative considerations,surgical techniques,postoperative protocols,outcomes in adults,postoperative complications,and PD catheter malfunction.Since that publication,the guidelines committee has adopted a more formal methodology using the Grading of Recommendations Assessment,Dev
17、elopment and Evaluation(GRADE)approach 2.MethodsThis document is an evidence-based guideline based on a systematic review of current literature and expert opinion.It provides specific recommendations to assist physicians who care for PD patients.Interpretation ofstrong andconditional recommendations
18、The strength of these evidence-based recommendations is either“strong”or“conditional”as per the GRADE approach 2,3.The phrase“the guideline panel recommends,”is used for strong recommendations and“the guideline panel sug-gests,”for conditional recommendations 2,4.Strong rec-ommendations can be adopt
19、ed as a policy in most situations.Conditional recommendations require shared decision-mak-ing between the surgeon and their patients.When insufficient evidence existed to inform recommendations,expert opinion consensus was sought.How touse these guidelinesThese guidelines are primarily intended to h
20、elp surgeons make decisions about the peri-operative management of their patients undergoing minimally invasive surgery.Other purposes are to educate,inform policy and advo-cacy,and to define future research needs.Guidelines are applicable to all physicians facing patient management uncertainties ad
21、dressed herein without regard to spe-cialty,training,or interests.Due to the complexity of the healthcare environment,these guidelines are intended to indicate the preferred,but not necessarily the only,accept-able approach to management.Guidelines are intended to be flexible depending on individual
22、 circumstances.Given the wide range of variation in any health care problem,the surgeon must always tailor the approach to the individual patient.These guidelines can also be used by patients as a basis of discussion with their treating surgeon.RecommendationsKQ1:In adult patients needing both renal
23、 replacement therapy and hernia repair,should hernia repair be per-formed concurrently with peritoneal dialysis catheter placement or be staged?The panel suggests staged hernia repair and peritoneal dialysis catheter placement rather than simultaneous oper-ations for adults needing both renal replac
24、ement therapy and hernia repair(conditional recommendation,very low certainty evidence).KQ2:Should urgent start(less than 2weeks)or tra-ditional start be used for adult and pediatric patients who are initiating peritoneal dialysis?For adult patients initiating peritoneal dialysis,the panel suggests
25、that traditional start is favored over urgent start.(conditional recommendation,very low certainty evidence).However,if urgent initiation of renal replacement ther-apy is deemed medically necessary,the panel suggests that the benefits of urgent start peritoneal dialysis may out-weigh the risks of in
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