腹膜透析发生急腹症的单中心回顾性分析  

作　　者：徐峰 童孟立[2] 

机构地区：[1]浙江省绍兴第二医院医共体总院,312000 [2]浙江中医药大学附属杭州市中医院,310007

出　　处：《浙江临床医学》2025年第2期228-230,共3页Zhejiang Clinical Medical Journal

摘　　要：目的分析腹膜透析(PD)患者发生急腹症的病因及预后,探讨PD患者发生急腹症的诊断及预防方法。方法选取2012年1月至2023年12月本院接受治疗的319例PD患者急腹症病例,回顾性分析病因、维持性腹膜透析时间、腹透液颜色、并发症、治疗及预后等。结果腹膜透析相关性腹膜炎(PDRP)患者共236例(73.98%),其次肠道感染15例(4.7%),消化道溃疡、糜烂、出血14例(4.39%),肠梗阻13例(4.08%),胆囊及胆道梗阻、胆囊炎发作12例(3.76%),腹膜透析隧道感染7例(2.19%),消化道肿瘤、急性阑尾炎各4例(1.25%)、急性胰腺炎3例(0.94%)、肠穿孔3例(0.94%)、腹部血管疾病、原因未明腹痛及腹部疝各2例(0.63%),子宫内膜异位症及肾囊肿伴感染各1例(0.31%)。性别和年龄对急腹症的影响差异无统计学意义(P>0.05)。女性较男性更常见胆囊炎、胆管炎症、梗阻(P<0.01)及肠道感染(P<0.02)。男性除单纯PDRP外,其他病因的发病率较高,其中腹部疝气仅见于男性,原因未明的腹痛及子宫内膜异位症仅见于女性,总体病因分布上差异有统计学意义(P<0.05)。急性阑尾炎多发生在腹透早期。腹透液浑浊多见于单纯PDRP,差异有统计学意义(P<0.01)。腹透液色清且不伴有PDRP的患者中,胃、十二指及结肠相关病变,胆囊及胆管炎症、结石梗阻性病变,腹腔脏器肿瘤,急性胰腺炎,原因未明腹痛及腹部血管疾病较为常见,差异有统计学意义(P<0.05)。单纯的PDRP相较于其他病因引起的发热腹痛,预后较好,差异有统计学意义(P<0.01)。结论PDRP是引起PD患者并发急腹症的最常见原因,其次是肠道感染和胃、十二指肠及结肠相关病变等。性别和年龄对急腹症影响差异无统计学意义。腹透液的浑浊更多见于单纯PDRP,单纯PDRP继续进行腹膜透析的机会更大。Objective To analyze the causes and prognosis of acute abdomen in peritoneal dialysis(PD)patients and to explore diagnostic and preventive methods for acute abdomen in PD patients.Methods A retrospective analysis was conducted on 319 cases of acute abdomen in PD patients treated at Hangzhou Traditional Chinese Medicine Hospital from January 2012 to December 2023,including causes,duration of maintenance peritoneal dialysis,color of dialysis fluid,complications,treatment,and prognosis.Results Peritoneal dialysis-related peritonitis(PDRP)was the most common cause,with 236 cases(73.98%),followed by intestinal infections in 15 cases(4.7%),gastrointestinal ulcers,erosions,and bleeding in 14 cases(4.39%),intestinal obstruction in 13 cases(4.08%),gallbladder and bile duct obstruction,and cholecystitis in 12 cases(3.76%),peritoneal dialysis tunnel infections in 7 cases(2.19%),gastrointestinal tumors,and acute appendicitis in 4 cases each(1.25%),acute pancreatitis in 3 cases(0.94%),intestinal perforation in 3 cases(0.94%),abdominal vascular diseases,unexplained abdominal pain,and abdominal hernias in 2 cases each(0.63%),and endometriosis and renal cysts with infection in 1 case each(0.31%).There was no statistically significant difference in the causes of acute abdomen related to gender and age.(P>0.05).Women were more likely to have gallbladder and bile duct inflammation,obstruction(P<0.01),and intestinal infections(P<0.02)than men.Men had a higher incidence of other causes of acute abdomen besides simple PDRP,with abdominal hernias seen only in men and unexplained abdominal pain and endometriosis seen only in women.There was a statistically significant difference in the overall distribution of causes(P<0.05).Acute appendicitis occurred more frequently in the early stages of peritoneal dialysis.The turbidity of the dialysis fluid was more common in simple PDRP,with a statistically significant difference(P<0.01).In patients with clear dialysis fluid without PDRP,conditions such as gastric and duodenal-related lesions,gallb

关 键 词：腹膜透析 急腹症 腹膜透析相关性腹膜炎 

分 类 号：R656.1[医药卫生—急诊医学] R459.5[医药卫生—外科学]