Gadallah M F, Mignone J, Torres C, Ramdeen G, Pervez A
Department of Medicine, University of Florida Medical Center, Jacksonville, USA.
Adv Perit Dial. 2000;16:47-50.
Migration of the peritoneal dialysis (PD) catheter from the pelvis to the upper abdomen frequently results in peritoneal dialysis failure and removal of the catheter. Previous studies compared PD catheter survival in various catheter configurations. These studies included single-cuff and double-cuff, straight-end and curled-end catheters, and showed an incidence of catheter migration ranging from 5%-35% depending on the catheter type. Recent studies demonstrated that the double-cuff, Swan-neck, curled-end configuration is associated with a considerably lower incidence of migration. Most of these studies, however, had a small patient sample or no control group, or they compared nonequivalent catheters (for example, Swan-neck, curled-end versus straight, non-curled-end). Over a six-year period, we examined two similar double-cuff, curled-end catheters: Group I catheters had a straight segment between the two cuffs, and Group II catheters had a 60 degrees Swan-neck bend between the two cuffs (Quinton Instrument Co., Bothell, WA, U.S.A.). The two catheters were identical, except for the presence or absence of the Swan-neck bend. All catheters were placed by the closed laparoscopic technique. In the two groups of patients in whom the catheters were implanted, no statistically significant difference was observed in primary disease, age, sex, race, weight, prior abdominal surgery, or duration of dialysis before catheter migration. In group I, 33 of the 219 patients developed catheter migration (15%); in group II, 2 patients of 243 patients developed catheter migration (less than 1%, p = 0.002). In conclusion, the Swan-neck configuration presents an independent factor in preventing PD catheter migration. Review of previous studies and the data from our study, show that double-cuff, curled-end, Swan-neck PD catheters are superior to other catheters in regard to prevention of catheter migration and should be the catheter of choice in PD patients.
腹膜透析（PD）导管从盆腔迁移至上腹部常常导致腹膜透析失败并需要拔除导管。以往的研究比较了各种导管构型下PD导管的留存情况。这些研究包括单套囊和双套囊、直端和卷曲端导管，结果显示导管迁移的发生率在5%至35%之间，具体取决于导管类型。近期研究表明，双套囊、天鹅颈、卷曲端构型与显著更低的迁移发生率相关。然而，这些研究大多样本量较小或没有对照组，或者比较的是不等同的导管（例如，天鹅颈、卷曲端与直的、非卷曲端）。在六年时间里，我们研究了两种相似的双套囊、卷曲端导管：I组导管在两个套囊之间有一段直管，II组导管在两个套囊之间有一个60度的天鹅颈弯曲（美国华盛顿州博塞尔市的昆顿仪器公司）。除了有无天鹅颈弯曲外，这两种导管完全相同。所有导管均通过闭合腹腔镜技术置入。在植入导管的两组患者中，在原发性疾病、年龄、性别、种族、体重、既往腹部手术或导管迁移前的透析时长方面，未观察到统计学上的显著差异。在I组中，219例患者中有33例发生导管迁移（15%）；在II组中，243例患者中有2例发生导管迁移（不到1%，p = 0.002）。总之，天鹅颈构型是预防PD导管迁移的一个独立因素。回顾以往研究以及我们的研究数据表明，双套囊、卷曲端、天鹅颈PD导管在预防导管迁移方面优于其他导管，应成为PD患者的首选导管。
