中国血液净化

中国血液净化 ›› 2012, Vol. 11 ›› Issue (11): 615-620.

• 专题 • 上一篇    下一篇

腹膜透析合并腹壁疝的危险因素及预后

徐天1,谢静远2,张春燕3,黄晓敏2,任红2,陈楠2   

  1. 1. 上海市交大医学院附属瑞金医院
    2. 上海交通大学医学院附属瑞金医院
    3.
  • 收稿日期:2012-07-30 修回日期:2012-08-26 出版日期:2012-11-12 发布日期:2012-11-12
  • 通讯作者: 陈楠 E-mail:chen-nan@medmail.com.cn

Risk factors and prognosis of peritoneal dialysis complicating with abdominal wall hernia

  • Received:2012-07-30 Revised:2012-08-26 Online:2012-11-12 Published:2012-11-12

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摘要： 目的：分析腹膜透析（PD）合并腹壁疝人群的临床特点，分析影响其预后的相关危险因素。方法：入选上海交通大学医学院附属瑞金医院肾脏科2006至2011年PD治疗的436例患者。收集基线情况、手术史、置管方式、实验室检查、透析剂量、透析充分性参数等。记录腹壁疝发生时间、部位、类型和治疗方案。根据有无腹壁疝分为A（对照组）、B（腹壁疝组）两组，比较两组的临床特点。应用Logistic回归分析PD患者合并疝的危险因素。结果：27例患者（6.2%）累计发生疝30例次，疝发生率0.054次/病人年，首次疝发生时间为开始PD治疗后（21.86±27.58）周。腹股沟疝22例（81.48%）（双侧4例、右侧12例、左侧6例）；切口疝2例（7.4%）；脐疝2例（7.4%）；多重疝1例（3.7%）。A（n=409）、B（n=27）两组糖尿病（27.62% vs 22.22%）、多囊肾（1.5% vs 0）、腹腔镜置管比例（8.31% vs 18.51%）无显著差异（P>0.05）。B组患者平均年龄（59.33±17.73 vs 65.07±13.27）；男性比例（54.27% vs 85.16%）和既往盆腹腔手术率（19.32% vs 37.04%）均高于A组（P<0.05）。B组平均体重指数（BMI）则明显低于A组（22.53± 3.52 vs 20.96±2.38 P<0.05）。两组基线时各项化验检查和初次透后评估结果，如：血糖、尿素氮、白蛋白、血红蛋白、血钙、血磷、铁蛋白、PTH、胆固醇、KT/V、Ccr、透析剂量、APD使用率均无明显差异（P>0.05），但B组血肌酐（697.00±370.50 vs 545.50±338.75 P<0.05）和甘油三酯水平（1.56±1.24 vs 0.98±0.92 P<0.05）均明显低于A组。进一步采用Logistic回归分析后发现血肌酐（OR=0.993，95%CI:0.987-0.99，P=0.040）和甘油三酯水平（OR=0.084，95%CI:0.008-0.893，P=0.041）与腹壁疝发生率呈明显负相关。B组患者接受补片修补术7例，复发2例；术后继续PD 5例（APD 2例），转HD 2例。非手术治疗20例，疝加重1例；继续维持PD 17例，肾移植2例，转HD 1例。结论：腹股沟疝是PD最常见的腹壁疝类型。盆腹腔手术史、体型瘦小、老年男性、营养状况差是PD合并疝的危险因素。

Abstract: Objective: To investigate the risk factors and outcome of the Peritoneal dialysis (PD) patients with abdominal wall hernia. Methods: We recruited 436 PD patients from Shanghai Ruijin Hospital. Baseline characteristics and follow-up data were recorded. All the participants were divided into Group A (normal group, n = 409) and Group B (hernia group, n = 27) based on whether abdominal wall hernia occurred. Logistic regression analysis was performed. Results: The hernia rate was 6.2% (30 events). The incidence of hernia was 0.054 times/patient years and the average time of first hernia was 21.86 ± 27.58 weeks. Among all patients, 22 were inguinal hernia (81.48%), 2 were incisional hernia(7.4%), 2 were umbilical hernia(7.4%) and 1 was multiple hernia(3.7%). There were similar diabetes (27.62% vs 22.22%), polycystic kidney disease (1.5% vs 0) and laparoscopic implantation of catheter (8.31% vs 18.51%) in two groups. Patients in group A were younger (59.33 ± 17.73 vs 65.07 ± 13.27), less male (54.27% vs 85.16%), less abdominal surgery history (19.32% vs. 37.04%) and higher body mass index (BMI) (22.53 ± 3.52 vs 20.96 ± 2.38) than group B (P <0.05). Two groups had similar baseline characterics. Patients in group A had higher serum creatinine (697.00 ± 370.50 vs 545.50 ± 338.75,) and triglycerides (1.56 ± 1.24 vs 0.98 ± 0.92) levels than group B. Serum creatinine (OR=0.993, P=0.04) and triglyceride (OR=0.084, P=0.04) were negatively correlated with hernia. Conclusion: Inguinal hernia is the most common type of abdominal wall hernia in PD patients. Previous abdominal surgery, smaller body size, older men and poor nutritional status were the risk factors of PD complicating with hernia.