Balaskas E V, Ikonomopoulos D, Sioulis A, Dombros N, Kassimatis E, Bamichas G, Katsara I, Tourkantonis A
1st Medical Department, AHEPA University Hospital, Thessaloniki, Greece.
Perit Dial Int. 1999;19 Suppl 2:S167-71.
This study reports our experience with permanent peritoneal catheters. From July 1983 until December 1997, 225 catheters were implanted surgically in 207 patients (120 males, 87 females) with mean age of 58+/-16 years (range: 2-82 years), and a mean duration of continuous peritoneal dialysis (CAPD) of 21.9+/-21.3 months (range: 1-145 months). Two hundred and seventeen catheters were used in 199 patients suffering from end-stage renal disease (ESRD), and 8 catheters in 8 patients with end-stage heart failure resistant to medical therapy. One patient used 3 catheters and 16 patients used 2 catheters. The catheters used were: Tenckhoff, 2; Oreopoulos-Zellerman-1 (OZ-1), 10; OZ-2, 205; and OZ-pediatric, 8. All catheters were implanted by the same surgical team, through a paramedian incision under local anesthesia. By life table analysis, the actuarial survival rates at 1 year, 2 years, 3 years, and 5 years were 97%, 92%, 87%, and 82% respectively for all catheters. The catheter-related complications were: 5 obstructions, 2 dislodgments, 13 dialysate leaks (6 early; 7 late), 90 exit-site/tunnel infections (in 56 patients), 2 cuff extrusions, and 37 hernias (in 31 patients). Eighteen catheters were replaced for persistent peritonitis (15 cases), dislodgment (1 case), obstruction (1 case), and accidental shortening (1 case). The total observation period was 4526 patient-months. The overall incidence of peritonitis was one episode per 15 patient-months, and of exit-site/tunnel infections was one episode per 50 patient-months, with a significant improvement during the last years. We conclude that OZ catheters implanted surgically through a paramedian incision have a very high survival rate and a low complication rate.
本研究报告了我们使用永久性腹膜导管的经验。从1983年7月至1997年12月，225根导管通过手术植入207例患者（男性120例，女性87例）体内，患者平均年龄58±16岁（范围：2 - 82岁），持续性腹膜透析（CAPD）平均时长21.9±21.3个月（范围：1 - 145个月）。199例终末期肾病（ESRD）患者使用了217根导管，8例药物治疗无效的终末期心力衰竭患者使用了8根导管。1例患者使用了3根导管，16例患者使用了2根导管。所使用的导管包括：Tenckhoff导管2根；Oreopoulos - Zellerman - 1（OZ - 1）导管10根；OZ - 2导管205根；OZ - 小儿导管8根。所有导管均由同一手术团队在局部麻醉下经旁正中切口植入。通过生命表分析，所有导管1年、2年、3年和5年的精算生存率分别为97%、92%、87%和82%。导管相关并发症包括：5例梗阻、2例移位、13例透析液渗漏（6例早期；7例晚期）、90例出口部位/隧道感染（56例患者）、2例袖套挤出和37例疝（31例患者）。18根导管因持续性腹膜炎（15例）、移位（1例）、梗阻（1例）和意外缩短（1例）而被更换。总观察期为4526患者 - 月。腹膜炎的总体发生率为每15患者 - 月1次发作，出口部位/隧道感染为每50患者 - 月1次发作，在过去几年中有显著改善。我们得出结论，经旁正中切口手术植入的OZ导管具有非常高的生存率和低并发症发生率。
