目的 探讨经皮穿刺腹膜透析置管术在儿童尿毒症患者中的有效性及安全性，并比较三种不同改良经皮穿刺置管术在临床应用中的优缺点。方法 采用单中心回顾性研究设计，选取2017年1月1日至2024年12月31日期间于肾脏内科因尿毒症首次接受经皮穿刺腹膜透析置管的患儿作为研究对象。根据手术方式将患儿分为三组：A组（穿刺套管针联合硬质导丝引导法）、B组（撕脱鞘联合硬质导丝引导法）及C组（建立气腹后Trocar联合硬质导丝引导法）。收集患儿基本资料、置管手术时间、手术切口渗血发生率、开始透析时间，以及开始规律腹膜透析后1年内导管功能障碍和腹膜透析相关感染的发生情况，并进行统计分析。结果 共纳入98例患儿，基线资料组间均衡，均接受规律腹膜透析≥1个月。75例透析≥6个月，53例透析≥12个月。三组手术时间差异有统计学意义（P<0.05），C组手术时间最短，显著短于A组（P<0.01）。术后各时间点的横断面分析显示，三组在切口渗血、开始透析时间、引流不畅、渗漏及腹膜透析相关感染方面差异均无统计学意义（P>0.05）。生存分析显示，A、B、C三组的1年导管生存率分别为0.89、0.79和0.96。但Cox多因素回归分析显示三种手术方式的1年导管生存率无显著差异。进一步针对三种主要导管相关不良事件的生存分析表明，各组在1年隧道口感染发生率和1年腹膜炎发生率上均无显著差异。然而，在引流不畅方面，C组的发生率显著高于A组（P=0.034）。结论 改良经皮穿刺置管术是一种安全有效、操作简便的腹膜透析置管方式，适合在儿童肾内科医师中推广应用。撕脱鞘联合硬质导丝引导法在手术时间与并发症控制方面综合表现最佳。建立气腹后Trocar引导法虽能显著提高手术效率，但也可能增加术后引流不畅的风险，建议在技术成熟的中心选择性应用。

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.