Patel U D, Mottes T A, Flynn J T
Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, Michigan, USA.
Adv Perit Dial. 2001;17:253-9.
Delayed use of the peritoneal catheter may be one method of reducing catheter-related complications in chronic peritoneal dialysis (PD); however, the risks and benefits of immediate as compared with delayed use have not been examined in children. We retrospectively analyzed 33 peritoneal catheter placements in 27 children between 1997 and 2000. Eleven catheters were used for PD immediately following insertion (group I); 22 catheters were used only after a delay averaging 20 days (group D). Characteristics of the children in the two groups were similar. Catheter-related complications within the first 3 months after placement--including dialysate leak, fibrin plug, outflow obstruction, cuff extrusion, herniation, exit-site and tunnel infection, peritonitis, and catheter revision and replacement--were evaluated. Rates of individual complications in the two groups were similar, but several trends were noted. Dialysate leaks were more common in group I (rate of 0.36 in group I vs 0.09 in group D), and infectious complications were more common in group D (rate of exit-site or tunnel infection of 0.14 in group D vs 0.09 in group I; rate of peritonitis of 0.36 in group D vs 0.18 in group I). We conclude from this small study that delayed use of the peritoneal catheter does not appear to convey significant advantages over immediate use; however, immediate use may be associated with more frequent dialysate leaks. On the other hand, delayed use may be associated with a greater risk of infection. Further studies involving larger numbers of children will be necessary to confirm these findings.
延迟使用腹膜导管可能是减少慢性腹膜透析（PD）中导管相关并发症的一种方法；然而，与延迟使用相比，立即使用的风险和益处尚未在儿童中进行研究。我们回顾性分析了1997年至2000年间27例儿童的33次腹膜导管置入情况。11根导管在插入后立即用于PD（I组）；22根导管仅在平均延迟20天后使用（D组）。两组儿童的特征相似。评估了放置后前3个月内与导管相关的并发症，包括透析液渗漏、纤维蛋白凝块、流出道梗阻、袖套挤出、疝、出口处和隧道感染、腹膜炎以及导管修复和更换。两组中个体并发症的发生率相似，但注意到了一些趋势。透析液渗漏在I组中更常见（I组发生率为0.36，D组为0.09），感染性并发症在D组中更常见（D组出口处或隧道感染发生率为0.14，I组为0.09；D组腹膜炎发生率为0.36，I组为0.18）。从这项小型研究中我们得出结论，延迟使用腹膜导管似乎并不比立即使用具有显著优势；然而，立即使用可能与更频繁的透析液渗漏有关。另一方面，延迟使用可能与更大的感染风险有关。需要进一步开展涉及更多儿童的研究来证实这些发现。
