Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente Bellflower Medical Center, Bellflower, California 90706 USA.
Perit Dial Int. 2006 Nov-Dec;26(6):677-83.
Guidelines for optimal peritoneal dialysis access support both downward and lateral exit-site directions. Numerous clinical reports support the superiority of downward exit sites but none substantiate lateral configurations.
This prospective study compared infectious and mechanical complications between 85 catheters with a preformed arcuate bend to produce a downward exit site and 93 catheters with a straight intercuff segment configured to create a lateral exit site.
Kaplan-Meier survivals were not different for time to first exit-site infection (p = 0.62), tunnel infection (p = 0.89), or peritonitis (p = 0.38) for downward and lateral exit-site directions. Poisson regression showed no differences in rates (episodes/patient-year) of exit-site infection (0.26 vs 0.27, p = 0.86), tunnel infection (0.02 vs 0.03, p = 0.79), peritonitis (0.42 vs 0.43, p = 0.87), or catheter loss (0.06 vs 0.09, p = 0.29) for downward and lateral exit sites. Kaplan-Meier analyses of antibiotic-free intervals for exit-site (p = 0.94) and peritonitis infections (p = 0.72) were not different for the two groups. There was one case of catheter tip displacement with flow dysfunction in each group. There were no pericatheter hernias or spontaneous cuff extrusions. Catheter survival between groups was not different (p = 0.20).
Catheter types employing downward and lateral tunnel-tract and exit-site configurations produce equivalent outcomes for infectious and mechanical complications.
腹膜透析置管最佳出口位置的指南支持向下和侧向出口方向。许多临床报告支持向下出口的优越性，但没有报告支持侧向置管的优越性。
本前瞻性研究比较了 85 例带有预成型弧形弯曲以形成向下出口的导管和 93 例带有直型带内袖口段以形成侧向出口的导管的感染和机械并发症。
Kaplan-Meier 生存分析显示，两组间首次出口部位感染（p = 0.62）、隧道感染（p = 0.89）和腹膜炎（p = 0.38）的时间无差异。泊松回归显示，两组间出口部位感染（0.26 与 0.27，p = 0.86）、隧道感染（0.02 与 0.03，p = 0.79）、腹膜炎（0.42 与 0.43，p = 0.87）和导管丢失（0.06 与 0.09，p = 0.29）的发生率（每患者年感染次数）无差异。两组间出口部位（p = 0.94）和腹膜炎感染（p = 0.72）的无抗生素间隔的 Kaplan-Meier 分析无差异。两组各有 1 例导管尖端移位伴流量功能障碍。无导管周围疝或自发性袖口脱出。两组间导管存活率无差异（p = 0.20）。
采用向下和侧向隧道-管道和出口部位构型的导管在感染和机械并发症方面产生相当的结果。
