Esson M L, Quinn M J, Hudson E L, Teitelbaum I
Division of Renal Disease and Hypertension, University of Colorado Health Sciences Center, Denver, USA.
Adv Perit Dial. 2000;16:123-8.
We performed a retrospective analysis of our institution's experience with the technique of delayed externalization of subcutaneously tunnelled peritoneal dialysis catheters. From 1993 to 1999, 49 catheters were implanted in 37 patients. Median age of the patients was 43.6 years; 70% were female; 32% had diabetes. Most of the catheters were midline, single-cuff, curled Quinton catheters without a swan neck. One patient underwent transplantation prior to catheter externalization. One catheter leaked prior to externalization and was removed. The remaining catheters were externalized a median of 40 days (range: 18-319 days) post implantation. At externalization, two leaks and one omental obstruction occurred, causing primary catheter failure. Total days of catheter follow-up were 17,895. One-year and two-year catheter survival rates were 70% and 40% respectively. Catheter failure occurred owing to infection in 7 cases and to mechanical complications in 10 cases. The rate of exit-site infection was 1 per 9.9 patient-months, and of peritonitis, 1 per 16.2 patient-months. Including primary failures, mechanical complications were 12 hernias, 6 leaks, and 4 instances of malposition. We conclude that delayed externalization of single-cuff catheters without a swan neck is associated with increased mechanical and infectious complications. These findings may warrant a change to a double-cuff catheter with a swan neck.
我们对本机构采用皮下隧道式腹膜透析导管延迟外置技术的经验进行了回顾性分析。1993年至1999年期间，37例患者植入了49根导管。患者的中位年龄为43.6岁；70%为女性；32%患有糖尿病。大多数导管为中线单套囊卷曲Quinton导管，无鹅颈设计。1例患者在导管外置前接受了移植手术。1根导管在外置前发生渗漏并被拔除。其余导管在植入后中位40天（范围：18 - 319天）进行了外置。在外置时，发生了2例渗漏和1例网膜阻塞，导致导管初次使用失败。导管随访总天数为17,895天。导管1年和2年生存率分别为70%和40%。导管失败的原因，7例是由于感染，10例是由于机械并发症。出口部位感染发生率为每9.9患者月1例，腹膜炎发生率为每16.2患者月1例。包括初次失败情况，机械并发症有12例疝、6例渗漏和4例位置异常。我们得出结论，无鹅颈的单套囊导管延迟外置与机械和感染并发症增加相关。这些发现可能需要改用带鹅颈的双套囊导管。
