中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (12): 674-677.doi: 10.3969/j.issn.1671-4091.2016.12.006

• 临床研究 • 上一篇    下一篇

不同类型腹膜透析导管的临床应用

周岩,周玉超,周婷婷,唐政,刘志红,俞雨生   

  1. 南京军区南京总医院 国家肾脏疾病临床医学研究中心
  • 收稿日期:2016-05-24 修回日期:2016-08-15 出版日期:2016-12-12 发布日期:2016-12-05
  • 通讯作者: 俞雨生 yuyusheng@medmail.com.cn E-mail:yuyusheng@medmail.com.cn

The catheter-related complications in peritoneal dialysis using different catheters: experience from 820 peritoneal dialysis cases

  • Received:2016-05-24 Revised:2016-08-15 Online:2016-12-12 Published:2016-12-05

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摘要： 目的回顾性总结820 例不同类型腹膜透析导管的并发症发生情况，掌握不同类型导管的优缺点，探讨如何合理选择导管类型。方法选取2002 年1 月～2011 年8 月在本中心置管行腹膜透析的终末期肾衰竭患者820 例，分别选用Tenckhoff 卷曲管(T 型曲管)、鹅颈型卷曲管(S-N 卷曲管)、鹅颈型直管(S-N 直管)。采用开放式外科手术置管法，由同一手术者操作，均以旁正中2cm 为手术切口。T 型曲管S 直管以耻骨联合上12cm 为置管位置，S 曲管根据不同置管阶段分别以耻骨联合上13cm、15cm、17cm 为置管位置。随访时间均大于3 个月，观察各种导管相关并发症的发生情况。结果共纳入腹膜透析置管术患者820 例，采用Tenckhoff 卷曲管231 例、鹅颈型卷曲管126 例、鹅颈型直管(S-N 直管)463 例。其中男性490 例，女性330 例，平均年龄(42.3±14.7)岁，慢性肾小球肾炎622 例，狼疮性肾炎52 例，糖尿病肾病65 例，慢性间质性肾炎22 例，高血压肾损害19 例，多囊肾10 例，其他30 例。导管移位情况：T 型曲管组、S-N 曲管组、S-N 直管组分别为12 例(5.2%)、19 例(15.1%)和9 例(1.9%)，χ2=36.900，P =0.001；其中S-N 曲管组以耻骨联合上13cm、15cm、17cm 为置管位置时发生导管移位的例数分别为5 例(3.9%)、6 例(4.7%)和8 例(6.3%)，χ2=3.121，P=0.268。3 组导管阻塞发生率分别为7 例(3.0%)、6 例(4.8%)和9 例(1.9%),χ2=3.161，P=0.206。重新置管的分别为6 例(31.5%)、10 例(40.0%)和7 例(38.9%)，χ2=12.255，P=0.002。导管自行复位的分别为1 例(8.3%)、4 例(21.0%)和6 例(66.7%)，χ2=10.364，P=0.006。3 组隧道感染分别为0 例、1 例(0.21%)和0 例，χ2=0.772，P=0.680；隧道口感染分别为2 例(0.86%)、2 例(0.21%)和2 例(0.79%)，χ2=3.857，P=0.145。结论鹅颈直管组的导管移位发生率最低。而鹅颈卷曲管组的导管移位率发生率高，且不易自行复位，重新置管率高。3 种导管的隧道及隧道口感染率类似。

关键词: 腹膜透析导管, 置管术, 并发症

Abstract: Objective To seek a suitable type of peritoneal dialysis (PD) catheter by comparing catheterrelated complications in patients used Tenckhoff coiled catheter, swan- neck coiled catheter or swan- neck straight catheter. Methods A total of 820 end- stage renal disease patients with catheterization for maintenance
PD in this center from Jan. 2002 to Aug. 2011 were enrolled in this study. The catheter used included Tenckhoff coiled catheter (n=231), swan-neck coiled catheter (n=126) and swan-neck pipe (n=463). Open surgery was used for the placement of the catheters. The incisions located at 2.5cm aside from the center line, 12cm above pubic symphysis for Tenckhoff coiled and swan-neck straight catheters, and 13cm, 15cm or 17cm above pubic symphysis for swan-neck coiled catheter according to the catheterization stage. They were followed up for more than three months, and catheter-related complications were observed. Results In the 820 patients, 490 cases were males and 330 cases were females with the average age of 42.3±14.7 years (13-92 years of age). The primary diseases for PD included chronic glomerulonephritis (n=622), lupus nephritis (n= 52), diabetic nephropathy (n=65), chronic interstitial nephritis (n=22), hypertensive renal damage (n=19), polycystic kidney disease (n=10), and other (n=30). Catheter dislocation was found in 12 cases (5.2%), 19 cases (15.1%) and 9 cases (1.9%) in Tenckhoff coiled, swan-neck coiled, and swan-neck straight catheter groups, respectively (χ2=36.900, P=0.001), and was found in 5 cases, 6 cases and 8 cases in swan-neck coiled catheter group placed the catheters 13cm, 15cm, and 17cm above pubic symphysis respectively (χ2=3.121, P=0.268). In Tenckhoff coiled, swan-neck coiled, and swan-neck straight catheter groups, catheter obstruction was found in 7 cases (3.0%), 6 cases (4.8%), and 9 cases (1.9%) respectively (χ2=3.161, P=0.206), re-catheterization was performed in 6 cases, 10 cases, and 7 cases respectively (χ2=12.255, P=0.002), reset of the dislocated catheters
occurred in one case, 6 cases, and 4 cases respectively (χ2=10.364, P=0.006), and tunnel orifice infection occurred in 2 cases in every groups (χ2=3.857, P=0.145). Conclusion The rate of catheter dislocation was lowest in swan-neck straight catheter group, and was highest in swan-neck coiled catheter group. In swan-neck coiled catheter group, the catheter dislocation was relatively difficult to be reset with higher rate of re-catheterization.

Key words: Peritoneal dialysis, Insertion of catheter, Complication