腹透导管技术并发症.ppt

腹膜透析导管技术的相关问题 王荣 于克洲 山东省立医院肾脏内科 Other complications included pericatheter or subcutaneous leak, hydrothorax, and miscellaneous. 200 of these patients experienced a total of 217 anatomic complications 16 patients had more than 1 complication. Hernias comprised 60.4% of all complications: 24.9% inguinal, 18.9% umbilical, 13.8% ventral, 2.3% femoral, and 0.5% intrathoracic. Other complications included pericatheter or subcutaneous leak (25.3%), hydrothorax (6.0%), and miscellaneous (8.3%). Peritoneal dialysis modalities in use at the time of complication were automated PD (52.3%), continuous ambulatory PD (38.6%), and nocturnal intermittent PD (9.1%). The overall incidence of hernias was 7%. 腹膜透析导管种类 导管置入技术 目前存在的问题 腹膜透析早期与晚期失败的原因 CONTRIBUTION OF EARLY FAILURE TO OUTCOME ON PERITONEAL DIALYSIS Perit Dial Int 2008; 28:259–267 * 腹膜透析导管种类 导管置入技术 目前存在的问题 腹膜透析早期与晚期失败的原因 由无毒的惰性材料制成, 可弯曲, 质量稳定 具备高的光洁度, 能够有效避免微生物在其表面聚集而发生腹膜炎 不透 X 线, 便于影像学检查 不受体温、 透析液酸碱度、透析液成分及消毒剂的影响而发生质量改变, 以防止长期使用过程中发生化学性腹膜炎和异物反应 导管应在皮下和腹膜上两个部位牢固地与组织结合, 以有效防止漏液和皮下隧道感染 具有良好的生物相容性, 不易被大网膜包裹。 理想的腹膜透析导管 ? Silicone rubber (nearly all catheters) ? Polyurethane (Cruz catheter) Two main materials The Most Commonly Used Catheters, by Inner and Outer Shaft Shape (A) Flex-Neck Tenckhoff catheter, silicone (Medigroup, Oswego,IL, U.S.A.); (B) Cruz Tenckhoff catheter, polyurethane; (C) Standard Tenckhof f catheter, silicone; (D) One intraperitoneal limb of the T-fluted catheter (Ash Advantage: Ash Advantage Technology, Lafayette, IN, U.S.A.), silicone. From S. Ash, with permission. 2.6 mm, the standard size of the Tenckhoff catheter, swan-neck catheter, Missouri swan-neck catheter, and TWH catheter 3.1 mm (Cruz catheter) 3.5 mm [Flex-Neck (Medigroup, Oswego, IL, U.S.A.)and Ash Advantage catheters] BMI 35 腹膜透析导管种类 导管置入技术 目前存在的问题 腹膜透析早期与晚期失败的原因 外科手术置管法 腹腔镜置管法 X线透视下置管术 导管置入技术 腹膜透析导管种类 导管置入技术 目前存在的问题 腹膜透析早期与晚期失败的原因 PD置管过程中常见的并发症 内脏损伤 导管移位 网膜包裹导管 透析管出水不畅 透析液渗漏 疝 腹膜炎及出口处感染 麻醉意外 导管位置不良 移位 堵塞或包裹所致的腹膜透析液引流不畅 腹膜透析液渗漏 疝 机械并