腹膜透析患者合并胆管结石成功诊治2例报告及文献复习  

Successfully diagnosed and treated of 2 peritoneal dialysis patients with cholangiolithiasis:a case report and literature review

作　　者：吴蕾 聂建东[1] 孙庆华[1] 史春迎[1] 唐雯[1] Wu Lei;Nie Jiandong;Sun Qinghua;Shi Chunying;Tang Wen(Department of Nephrology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院肾内科,北京100191

出　　处：《中国综合临床》2024年第3期212-215,共4页Clinical Medicine of China

基　　金：中华国际医学交流基金会-肾性贫血科研基金(Z-2017-24-2037)。

摘　　要：目的总结2例腹膜透析患者合并胆管结石接受内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)治疗成功诊治经验。方法回顾性分析2例北京大学第三医院腹膜透析合并胆管结石患者接受ERCP联合内镜下乳头括约肌切开术治疗好转出院的临床资料,观察成功的胆管结石取出和手术相关的不良事件,如胰腺炎等,总结经验,并进行文献复习。结果2例患者总体结石取出成功率为100%,治疗后恢复良好,未发生术后严重出血,1例发生ECRP术后胰腺炎,继发性腹膜炎,经积极的抗感染治疗未影响腹膜功能,在围手术期维持了规律的腹膜透析,术后密切随诊并机动地调整腹膜透析剂量和浓度,保障患者平稳过渡到了规律稳定的腹膜透析。结论ERCP是腹膜透析合并胆总管结石患者可行的治疗方式,腹膜透析患者可较好耐受。腹膜透析患者的治疗需要长期的随访和管理,发生急性合并症时需要多学科合作。Objective To summarize the successful diagnosis and treatment experience of two patients with peritoneal dialysis complicated with cholangiolithiasis and cholangitis who received endoscopic retrograde cholangiopancreatography(ERCP).Methods A retrospective analysis was conducted on the clinical data of two patients with peritoneal dialysis combined with bile duct stones at Peking University Third Hospital who underwent ERCP combined with endoscopic sphincterotomy and were successfully transferred out of the hospital.Observe successful removal of bile duct stones and adverse events related to surgery,such as pancreatitis,summarize experience,and conduct literature review.Result The overall success rate of stone removal in 2 patients was 100%,and they recovered well after treatment without severe postoperative bleeding.One patient developed postoperative pancreatitis and secondary peritonitis after ECRP,and active anti infection treatment did not affect peritoneal function.Regular peritoneal dialysis was maintained during the perioperative period,and postoperative close follow-up and flexible adjustment of peritoneal dialysis dose and concentration were carried out to ensure a smooth transition of patients to regular and stable peritoneal dialysis.Conclusion ERCP is a feasible treatment for PD patients combined with choledocholithiasis,and can be well tolerated by them.The treatment of peritoneal dialysis patients requires long-term follow-up and management,and multidisciplinary cooperation is required when acute complications occur.

关 键 词：腹膜透析 胆管结石胆囊炎 内镜逆行胰胆管造影 乳头括约肌切开术 术后并发症 围手术期管理 多学科合作 

分 类 号：R692.5[医药卫生—泌尿科学] R575.62[医药卫生—外科学]