伴外科并发症的腹膜透析腹膜炎11例及文献复习  

Peritoneal dialysis-related peritonitis with surgical complications:report of 11 cases and review of the literature

作　　者：杨志凯[1] 周正飞[2] 董捷[1] 周福德[1] 

机构地区：[1]北京大学第一医院肾内科、北京大学肾脏病研究所、卫生部重点实验室、教育部慢性肾脏病防治重点实验室(北京大学),北京100034 [2]北京大学第一医院普通外科、北京大学肾脏病研究所、卫生部重点实验室、教育部慢性肾脏病防治重点实验室(北京大学),北京100034

出　　处：《中国血液净化》2017年第4期255-257,共3页Chinese Journal of Blood Purification

摘　　要：目的分析伴外科并发症的腹膜透析腹膜炎患者的治疗选择及预后。方法对2006~2013年本中心因腹膜炎住院的腹膜透析患者进行病历调查。结果该时段内共514名患者出现腹膜炎,伴外科并发症者11例(包括肠梗阻、疝、胃肠穿孔、阑尾周围炎、腹腔脓肿)。该11名患者经验性抗生素治疗无效。6人进行开腹探查并行手术干预(外科治疗组)。腹膜透析管拔管中位时间5天,拔管后进行外科干预的中位时间5天。总体死亡率45.5%(5/11),外科治疗组死亡率16.7%(1/6),内科保守治疗组死亡率80%(4/5)。两组患者在年龄、透析龄、拔管时间、最高C反应蛋白(C-reactive protein,CRP)水平、住院日、是否合并败血症上均无统计学差异。结论这是迄今最大的伴外科并发症的腹膜透析腹膜炎病例系列。腹膜透析腹膜炎患者伴发外科并发症应尽早开腹探查。Objective To investigate treatment strategy and outcome of the peritonitis with indications of surgical intervention in CAPD patients. Methods A retrospective chart review was performed on all episodes of peritonitis in a single PD center between 2006 and 2013. Results We presented 11 cases of severe peritonitis with surgical complications including ileus, hernia, gastrointestinal perforation, peri-appendicitis and intraabdominal abscesses in a period when a total of 514 episodes of peritonitis were recorded. All of the 11 cases failed to respond to empirical antibiotics. Only 6 patients were treated with exploratory laparotomy and surgical intervention. The median time of PD catheter removal was 5 days, and the median time from PD catheter removal to surgical intervention was 5 days. The overall mortality was 45.5% （5/11 patients died）. The mortality was 16.7% （1/6 died） in patients with surgical intervention, and was 80% （4/5 died） in those only with medication therapy. There were no statistically differences in age, PD duration, PD catheter removal time, the highest CRP level, hospitalization day, and the presence of sepsis between the two groups Conclusions This is the largest case series of PD-related peritonitis with surgical complications to date. Early exploratory laparotomy may improve the outcome of the PD-related peritonitis patients suspicious of surgical complications.

关 键 词：腹膜透析(腹膜透析) 腹膜炎 外科手术 

分 类 号：R459.5[医药卫生—治疗学]