延迟拔管的腹膜透析相关性腹膜炎救治新技术的建立与应用  

Establishment and Application of a New Treatment Technique for Peritoneal Dialysis Associated Peritonitis with Delayed Removal of the Peritoneal Catheter

作　　者：庄永泽 张路英 王烈 肖春红 俞国庆 李俊霞 黄翠红 ZHUANG Yongze;ZHANG Luying;WANG Lie(Department of Nephrology,900 Hospital of the Joint Logistics Team,PLA,Fuzhou 350025)

机构地区：[1]中国人民解放军联勤保障部队第九〇〇医院,福建医科大学福总临床医学院肾脏病科,福州350025 [2]中国人民解放军联勤保障部队第九〇〇医院普通外科,福州350025

出　　处：《中国中西医结合肾病杂志》2020年第11期951-954,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：福建省省引导性项目(No.2017Y0073);福建省临床重点专科建设项目。

摘　　要：目的:探讨在延迟拔管的腹膜透析相关性腹膜炎(PDAP)中综合救治新技术建立及疗效。方法:延迟拔管的PDAP患者50例,根据是否采用综合救治新技术分为A、B两组。A组(新技术组,n=27,其中17例腹腔镜或剖腹探查下拔管+肠黏连松解术、16例腹腔双套管负压持续冲洗引流术)、B组(旧技术组,n=23,传统单纯拔管+抗感染治疗),通过回顾性病例对照研究,比较两组的疗效。结果:新技术组与旧技术组在人口学、原发病、并发症、腹膜炎体征及实验室有关指标无显著差异,腹膜炎至拔管时间中位数分别为13 d、21 d,P=0.09,但新技术组60 d及90 d存活率明显高于旧技术组,分别为100%vs 78.3%(P=0.02),96.3%vs 73.9%(P=0.04)。结论:腹腔镜及腹腔双套管负压持续冲洗引流术是救治延迟拔管的PDAP的关键技术。综合救治新技术可明显提高了延迟拔管的PDAP患者的存活率。Objective:To explore the establishment and effect of the new comprehensive treatment of Peritoneal Dialysis Associated Peritonitis(PDAP)with delayed peritoneal catheter removal.Methods:50 PDAP patients with delayed removal of the peritoneal catheter were divided into group A and group B.Group A represented the new comprehensive treatment method,consisting of 27 cases.Among them there were 17 cases who accepted catheter removing and enterolysis under laparoscopy or exploratory laparotomy,and 16 cases using continuous negative pressure peritoneal irrigation drainage with peritoneal cavity double cannula.Group B represented the traditional treatment,consisting of 23 cases with only catheter removal method and anti-infection therapy.A retrospective case-control study was conducted to compare the efficacy of the two groups.Results:There was no significant difference between Group A and B in demographic characters,primary diseases,complications,signs of peritonitis and related laboratory indices.The median durations between peritonitis and removal of peritoneal catheter was 13 days and 27 days for Group A and B respectively(P=0.09).However,the 60-day and 90-day survival rates of Group A were significantly higher than those in Group B(60-day survival rate of 100.0%vs.78.3%,P=0.02;and 90-day survival rate of 96.3%vs.73.9%,P=0.04).Conclusion:Laparoscopy and peritoneal cavity double cannula under pressure continuous irrigation and drainage are key techniques to treat PDAP with delayed removal of the peritoneal catheter.The new comprehensive treatment significantly may improves patients’survival rates.

关 键 词：腹膜透析相关性腹膜炎 腹膜透析 腹腔镜 剖腹探查 腹腔负压持续冲洗引流术 

分 类 号：R459.5[医药卫生—治疗学] R572.2[医药卫生—临床医学]