Tiong H Y, Poh J, Sunderaraj K, Wu Y J, Consigliere D T
Department of Urology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074.
Singapore Med J. 2006 Aug;47(8):707-11.
The objective of this study was to audit the early and late complications of open Tenckhoff catheter insertion under local anaesthesia in a single institution.
A review was carried out on 164 insertions in 139 patients over a three-year period. All patient records were retrospectively analysed until the time of transfer to haemodialysis, death, or to current time if alive and receiving continuous ambulatory peritoneal dialysis (CAPD). Patient characteristics, operative factors, early and late complications were recorded.
Early complications were reported in 31 percent of catheter insertions, predominantly wound infections and catheter malfunctions. The factors that were significantly associated with early complications were diabetes mellitus, glomerulonephritis, ongoing sepsis, previous abdominal surgery and prolonged surgical time. Late complications were seen in 26 percent of catheter insertions, mainly CAPD peritonitis. Poor nutritional status had a significant negative impact on late complications. The overall median catheter survival time was 41.9 months (95 percent confidence interval, 25.8-58.0 months). In addition, no significant difference in catheter survival time was detected between those patients with and those without diabetes mellitus.
Tenckhoff catheter insertion for CAPD is a procedure associated with significant surgical morbidity. Patients with diabetes mellitus, glomerulonephritis and ongoing sepsis are at greater risk of early complications, and hence, must have their conditions stabilised or treated before surgery. In addition, prolonged surgical time and patients with previous abdominal surgery are at increased risk. The rate of complications may be improved by early consideration of patients with poor tolerance of local anaesthetic surgery or with previous abdominal surgery for laparoscopic insertion under general anaesthesia. To prevent late complications dominated by CAPD peritonitis, patients' nutritional status and care of the catheter should both be optimised.
本研究的目的是对在单一机构中局部麻醉下开放式Tenckhoff导管插入术的早期和晚期并发症进行审查。
对三年期间139例患者的164次导管插入进行了回顾。所有患者记录均进行回顾性分析，直至转为血液透析、死亡，或如果患者存活且接受持续性非卧床腹膜透析（CAPD）则直至当前时间。记录患者特征、手术因素、早期和晚期并发症。
31%的导管插入报告了早期并发症，主要是伤口感染和导管故障。与早期并发症显著相关的因素是糖尿病、肾小球肾炎、持续性败血症、既往腹部手术和手术时间延长。26%的导管插入出现晚期并发症，主要是CAPD腹膜炎。营养状况差对晚期并发症有显著负面影响。导管总体中位存活时间为41.9个月（95%置信区间，25.8 - 58.0个月）。此外，糖尿病患者和非糖尿病患者之间的导管存活时间未检测到显著差异。
CAPD的Tenckhoff导管插入术是一种伴有显著手术发病率的操作。糖尿病、肾小球肾炎和持续性败血症患者发生早期并发症的风险更高，因此，术前必须使其病情稳定或得到治疗。此外，手术时间延长和既往有腹部手术史的患者风险增加。对于局部麻醉手术耐受性差或既往有腹部手术史的患者，早期考虑在全身麻醉下进行腹腔镜插入术，可能会提高并发症发生率。为预防以CAPD腹膜炎为主的晚期并发症，应优化患者的营养状况和导管护理。
