外科角度下腹膜透析相关难治性硬化性腹膜炎15例诊疗分析  

Diagnosis and treatment of refractory peritonitis associated with peritoneal dialysis from a surgical perspective:a retrospective study of 15 cases

作　　者：张博闻 黄丽涵 江俊晖 杜俊豪 蔡庆龙 纪辉涛 洪伟煊 房俊伟 王烈 肖春红 ZHANG Bowen;HUANG Lihan;JIANG Junhui;DU Junhao;CAI Qinglong;JI Huitao;HONG Weixuan;FANG Junwei;WANG Lie;XIAO Chunhong(Department of General Surgery,Dongfang Affiliated Hospital of Xiamen University,school of Medicine,Xiamen University/Fuzong Clinical Medical College of Fujian Medical University/College of Integrative Medicine Fujian University of Traditional Chinese Medicine/The 900th Hospital of Joint Logistics Support Force,PLA,Xierhuanbei Road,NO.156,Fuzhou,Fujian 350025,China)

机构地区：[1]厦门大学附属东方医院/福建医科大学福总临床医学院/福建中医药大学中西医结合学院/联勤保障部队第九〇〇医院普通外科,350025 [2]福建医科大学孟超肝胆医院甲状腺乳腺头颈外科

出　　处：《临床外科杂志》2024年第10期1059-1063,共5页Journal of Clinical Surgery

基　　金：联勤保障部队第九〇〇医院院内课题(2021MS02&2023GK01);青年自主创新项目孵化专项(2022QC07)。

摘　　要：目的探讨腹膜透析相关难治性硬化性腹膜炎的外科诊治策略。方法2014年6月30日~2018年5月30日我院普通外科治疗的腹膜透析相关难治性硬化性腹膜炎病人15例,行开腹腹透管拔除+肠粘连松解+腹腔感染冲洗置管引流术5例,行腹腔镜下腹透管拔除+肠粘连松解+腹腔感染冲洗置管引流术4例,行腹腔镜下腹膜透析管拔除+腹腔感染冲洗置管引流术3例,行开腹腹膜透析管拔除+腹腔感染冲洗置管引流术2例,行腹腔镜检查联合剖腹探查下腹透管拔除+肠粘连松解+腹腔感染冲洗置管引流术1例。收集病人年龄、性别、临床症状、腹部CT检查、外周血常规、血生化、血C-反应蛋白(CRP)、腹透液白细胞、生化、腹透液病原学检验和随访情况,并评估疗效。结果15例病人均在内科治疗无效后转至外科治疗,术前(抗生素治疗5天后)和抗生素治疗前血WBC、血NEUT%、CRP、腹透液WBC无明显变化,差异无统计学意义(P>0.05)。手术中拔腹透管,清除腹腔感染灶,术后留置腹盆腔冲洗引流管。术后14例病人康复良好,腹膜炎症状得到有效控制,没有出现肠梗阻、肠瘘等并发症,腹透管拔除后均改为血液透析。术前和术后的炎症指标对比显示,术后明显下降。术后3天与术前(抗生素治疗5天后)比较,血WBC、血NEUT%、CRP、腹透液WBC均无明显变化,差异无统计学意义(P>0.05)。术后7天和术前(抗生素治疗5天后),血WBC分别为(7.43±2.65)×10^(9)/L和(10.17±5.24)×10^(9)/L、血NEUT%分别为(88.23±9.02)%和(85.07±11.57)%、CRP分别为(152.88±113.01)mg/L和(114.49±92.97)mg/L,差异有统计学意义(P<0.05),腹透液WBC与术前(抗生素治疗5天后)比较,无明显变化(P>0.05)。病例随访22~36个月,13例病人未再次发生腹膜炎或肠梗阻,1例病人术后39天因多器官功能衰竭死亡,1例病人术后随访2年后死于其他原因。结论对于内科保守治疗无效的腹膜透析相关难治性硬化性�Objective To evaluate the surgical treatments of refractory sclerosing peritonitis related peritoneal dialysis.Methods Clinical data of 15 patients with refractory sclerosing peritonitis related to peritoneal dialysis treated in the General Surgery Department of the 900th Hospital of the Joint Logistics Support Force of the People’s Liberation Army from June 30,2014 to May 30,2018.Among them,5 cases underwent“open abdomen peritoneal catheter removal+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter”,4 cases underwent“laparoscopic peritoneal catheter removal+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter”,3 cases underwent“laparoscopic peritoneal dialysis catheter removal+abdominal infection flushing and drainage with catheter”,2 cases underwent“open abdomen peritoneal dialysis catheter removal+abdominal infection flushing and drainage with catheter”,and 1 case underwent“laparoscopic examination combined with laparotomy exploration and removal of lower abdominal catheter+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter”.Age,gender,clinical symptoms,abdominal CT examination,peripheral blood routine,blood biochemistry,blood C-reactive protein(CRP),white blood cells,biochemistry,and aetiology of peritoneal dialysis fluid were collected and followed up,and the therapeutic effect was evaluated.Results 15 patients were transferred to the Department of Surgery after ineffective treatment in the Department of Internal Medicine.Preoperatively(after 5 days of antibiotic treatment)compared to before antibiotic treatment,there were no significant changes in blood WBC,blood NEUT%,CRP,and peritoneal fluid WBC(P>0.05).Laparoscopic exploration or laparotomy exploration was performed,during which the peritoneal dialysis catheter was removed and the abdominal infection focus was cleared.A pelvic cavity washout drainage tube was left in place postoperatively.Fourteen patients had a good recovery after surgery,with effe

关 键 词：腹膜透析 外科手术 硬化性腹膜炎 腹膜透析相关性腹膜炎 

分 类 号：R656.41[医药卫生—外科学] R692.5[医药卫生—临床医学]