Jo Young-Il, Shin Sug Kyun, Lee Jong-Ho, Song Jong-Oh, Park Jung-Hwan
Division of Nephrology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Perit Dial Int. 2007 Mar-Apr;27(2):179-83.
To evaluate the effect of a modified method of percutaneous catheter placement without a break-in procedure on the development of catheter-related complications in patients on continuous ambulatory peritoneal dialysis (CAPD).
A prospective, observational clinical study.
Peritoneal dialysis (PD) units of two university-based hospitals.
This study included 51 consecutive patients on CAPD. A straight double-cuffed Tenckhoff catheter with a straight intraperitoneal segment was used, and all catheters were inserted using a modified percutaneous placement method under local anesthesia. The catheter was introduced directly into the deep pelvis through an intramuscular tract, which had been created by tapered dilators. Peritoneal dialysis was initiated immediately after catheter insertion without a break-in procedure. Catheter-related complications were surveyed during the 12 months after initiation of CAPD.
Within the first month, only 1 pericatheter leakage (1.9%) was detected. There were no cases of visceral perforation or severe hemorrhage during catheter insertions. Catheter malfunction due to catheter tip migration, exit-site infection, and peritonitis developed in only 1.9%, 3.9%, and 3.9% of patients, respectively. After 1 month following catheter insertion, no further incidences of pericatheter leakage occurred during the follow-up period. All catheters, except one that was reinserted due to tip migration, survived throughout the study period.
The rates of pericatheter leakage and other catheter-related complications are relatively low in CAPD patients using our percutaneous catheter placement method without a break-in procedure. This procedure is comparatively simple and less invasive than other catheter placement methods, and allows for immediate start of PD after catheter insertion, without a break-in procedure.
评估一种改良的无导入期经皮置管方法对持续性非卧床腹膜透析（CAPD）患者导管相关并发症发生情况的影响。
一项前瞻性观察性临床研究。
两所大学附属医院的腹膜透析（PD）单元。
本研究纳入51例连续的CAPD患者。使用带有直形腹膜内段的直型双套Tenckhoff导管，所有导管均在局部麻醉下采用改良经皮置管方法插入。导管通过由锥形扩张器形成的肌内通道直接引入深盆腔。导管插入后立即开始腹膜透析，无导入期。在CAPD开始后的12个月内对导管相关并发症进行调查。
在第一个月内，仅检测到1例导管周围渗漏（1.9%）。置管过程中无内脏穿孔或严重出血病例。因导管尖端移位、出口部位感染和腹膜炎导致的导管功能障碍分别仅在1.9%、3.9%和3.9%的患者中发生。导管插入1个月后，随访期间未再发生导管周围渗漏。除1例因尖端移位而重新置管的导管外，所有导管在整个研究期间均存活。
使用我们的无导入期经皮置管方法的CAPD患者，导管周围渗漏和其他导管相关并发症的发生率相对较低。该方法比其他置管方法相对简单且侵入性较小，并且允许在导管插入后立即开始腹膜透析，无需导入期。
