腹膜透析置管术中X线辅助导管定位对相关并发症的影响  

The application of X-ray for positioning catheter during peritoneal dialysis catheter implantation on peritoneal dialysis-related complications

作　　者：蔡得汉[1] 罗富里 刘鸿[1] 魏小昌[1] 杨林[1] 钟爱民[1] 李赟[1] 

机构地区：[1]江西省人民医院肾内科,南昌330006

出　　处：《中国血液净化》2014年第2期74-76,共3页Chinese Journal of Blood Purification

摘　　要：目的 探讨腹膜透析置管术中X线辅助导管定位对减少腹膜透析相关并发症的有效性.方法 2009年4月1日～2012年6月30日在江西省人民医院肾内科住院的终末期肾脏病（慢性肾脏病5期）腹膜透析置管患者124例,随机分为置管组（A组）与X线辅助导管定位组（B组）各62例,2组男/女比例分别为35/27例比40/22例,平均年龄（岁）37.5±10.2比39.6±11.8;A组采用传统开腹腹膜透析置管术,B组步骤同A组,但在收紧荷包前用小C臂机行盆腔X线检查,见导管腹内端位于真骨盆内.比较2组术后腹腔出血、管周渗漏和1月及1年内导管移位、网膜包裹、腹膜炎等并发症发生率差异.结果 A、B2组患者术后的腹腔出血发生率分别为3.2％、6.5％ （P=0.3994）;2组均无渗漏;A、B两组1月内导管移位率分别为6.4％、0,有显著统计学差异（P=0.0421）,1月内网膜包裹（0比1.6％,P=0.3154）及腹膜炎（1.6％比0,P=0.3154）的发生率,2组无明显差异;1年内导管移位（3.2％比1.6％ P=0.5587）、网膜包裹（0比0）及腹膜炎（1.6％比1.6％）的发生率2组无明显差异;患者术后1年内发生腹腔出血、渗漏、导管移位、腹膜炎及网膜包裹等总的并发症发生率A组较B组高,分别为16.1％、11.3％,但2组无显著统计学差异（P=0.4237）.结论 腹膜透析置管术中X线辅助导管定位可显著减少近期（1月内）导管移位的发生,降低1年内腹膜透析置管术总的相关并发症,值得临床推广.Objective Placement of peritoneal dialysis （PD） catheter to correct site in abdominal cavity was critical for peritoneal dialysis.In this study,we investigated the application of X-ray for positioning catheter during peritoneal dialysis catheter implantation in order to eliminate the PD-related complications.Methods A total of 124 patients diagnosed with chronic kidney disease grade 5 during the period from April 1,2009 to June 30,2012 were randomly assigned to conventional operation group （group A,n=62） and X-ray positioning group （group B,n=62）.The procedures were the same for both groups,except that X-ray examination using a small C-arm instrument was performed to confirm the catheter tip at the bottom of true pelvis before fixation of the catheter in group B.After the operation for one month and one year,bleeding,leakage,catheter displacement,circumvolution by omentum,and peritonitis were compared between the two groups.Results Bleeding occurred in 3.2％ and 6.5％ of the patients in group A and B,respectively （P=0.3994）,and leakage did not happen in both groups.In group A and B after the operation for one month,the rate of catheter displacement was 6.4％ and 0,respectively （P=0.0421）,however,there were no differences in circumvolution by omentum （0 vs.1.6％,P=0.3154）,and peritonitis （1.6％ vs.0,P=0.3154）.In group A and B after the operation for one year,there were no differences in the rate of catheter displacement （3.2％ vs.1.6％,P=0.5587）,circumvolution by omentum （0 vs.0）,and peritonitis （1.6％ vs.1.6％）; the overall prevalence of bleeding,leakage,catheter displacement,peritonitis,and circumvolution by omentum was higher in group A （16.1％） than in group B （11.3％） but without statistical significance （P=0.4237）.Conclusion X-ray examination for positioning catheter during peritoneal dialysis catheter implantation is useful for the prevention of early catheter displacement （within one month） and the overall prevalence of peritoneal dialysis

关 键 词：腹膜透析置管术 导管定位 并发症 

分 类 号：R459.5[医药卫生—治疗学]