体外徒手腹膜透析导管拔除术的临床应用  

Clinical application of peritoneal dialysis catheter removal by pull technique

作　　者：成水芹 陈赟敏 周婷婷 张志宏 王芳 吕桂兰 王金泉 俞雨生 CHENG Shuiqin;CHEN Yunmin;ZHOU Tingting;ZHANG Zhihong;WANG Fang;LYU Guilan;WANG Jinquan;YU Yusheng(National Clinical Research Center of Kidney Diseases,Jinling Hosptial,Nanjing University School of Medicine,Nanjing 210016,China)

机构地区：[1]东部战区总医院国家肾脏疾病临床医学研究中心全军肾脏病研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2020年第6期531-535,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：江苏省临床医学中心项目(YXZXA2016003)。

摘　　要：目的:回顾性分析体外徒手腹膜透析(PD)导管拔除术在PD患者中的临床应用,评估手术效果及并发症。方法:回顾2018年9月至2019年11月国家肾脏疾病临床医学研究中心运用体外徒手方法拔除PD导管的患者,分析患者的一般资料、拔管方法、术中术后特点及术后并发症,并随访至少1年。结果:共纳入45例患者,男性21例、女性24例,平均年龄43.7±14.5岁,PD导管使用时长62(11.5~94)个月,拔管时长23.6±3.8s。45例患者均成功拔除PD导管,其中41例患者拔管后出口愈合良好;3例患者出口处持续少量渗液,出现愈合较慢,其中2例患者经换药加压包扎后逐渐愈合,1例患者予缝合导管出口处后皮肤逐渐愈合;1例患者出现浅涤纶套处感染,在隧道出口处分离组织与浅涤纶套,感染消失,愈合较好。所有患者均未出现新发腹膜炎、渗血、PD导管断裂、黏连性肠梗阻、腹膜疝等并发症。术后3个月、半年及1年时随访患者无任何拔管相关并发症。结论:体外徒手PD导管拔除术相对快速、简单、有效、微创且并发症少,可作为临床中PD导管拔除的常用方法。Objective:To analyze the clinical application of peritoneal dialysis(PD)catheter removal by pull technique,evaluate the surgical effect and complications in these patients.Methodology:Clinical data,intraoperative and postoperative characteristics,postoperative complications of the patients with the pull technique method of PD catheters extubation recruited from September 2018 to November 2019 were retrospectively analyzed,and the patients were followed up for at least 1 year.Results:A total of 45 patients were included,including 21 males and 24 females,with an average age of 43.7±14.5 years old.PD catheter was used for 62(11.5~94)months.Catheter extubation time was an average of 23.6±3.8 s.PD catheters were successfully removed in all patients.The tunnel exit healed well in 41 patients after extubation.3 patients had a small amount of exudate at the tunnel exit and healed slowly,of which 2 patients healed gradually after dressing change and pressure dressing,1 patient healed gradually after suture at the tunnel exit.1 patient developed infection at retained dacron cuff near the tunnel exit,when the retained dacron cuff was separated from the tissue,the infection disappeared and the exit healed.No complications such as new peritonitis,bleeding,PD catheter rupture,adhesion ileus or peritoneal hernia occurred in all patients.No extubation-related complications were found in the follow-up at 3 months,6 months and 1 year in these patients.Conclusion:PD catheter removal by pull technique is a relatively rapid,simple,effective,less invasive and less complicated operation method,which can be used as a common method of PD catheter removal in clinic.

关 键 词：腹膜透析 导管拔管术 体外徒手 并发症 

分 类 号：R692.5[医药卫生—泌尿科学]