腹透导管技术并发症要点解析.ppt

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 To analyze the importance of early treatment failure in PD and to compare early with late failures with respect to reasons and predictors of risk for failure. Early failure of PD is frequent and makes an important contribution to overall PD outcome. In our population, one third of all PD failures and 40% of all technique failures occurred within the first 6 months following catheter implantation. Identification of the main causes of early PD failure (catheter implantation, psychosocial problems) is the first step to improving outcome by interventions (e.g., improvement of catheter implantation technique, support to prevent psychosocial problems). 腹部和盆腔手术史对终末期肾病患者 腹膜透析导管置管的影响 有腹部和盆腔手术史(A)组 25 例 无腹部和盆腔手术史(B)组 86 例 其中 A组具体手术如下: 阑尾切除术 7 例、 肾盂切开取石术 7 例、 胆囊切除术 6 例、 输卵管结扎术 1 例、剖宫产术 2 例、 子宫切除术 1 例、 胃大部切除术 2例和脾脏切除术 1 例, 其中 2 例曾接受 2 种手术治疗。 丁小强等内科理论与实践 2007 年第 2 卷第 6 期 对先前有腹部和盆腔手术史的 ESRD 患者, 如腹部手术范围较小、 估计腹腔内粘连较轻者, 一般仍可选择 PD 治疗。既往腹部和盆腔手术史对 ESRD患者 PD导管放置后短期和长期并发症的发生率没有显著影响。 Tiong 等分析了 164例 CAPD置管手术患者, 结果发现 43 例先前有腹部手术史的患者中有 18 例( 41.9%)置管术后出现短期(≤30 d)并发症(如伤口出血或感染、 导管移位、 出口处出血或感染、 早期腹膜炎、 管周腹透液渗漏等) ,而 121 例无腹部手术史的患者中只有 32 例( 26.4%)置管术后出现短期( 30 d)并发症。作者认为先前腹部手术史是 CAPD 短期并发症的高危因素。