Li Chiu-Leong, Cui Tai-Gen, Gan Hong-Bing, Cheung Kin, Lio Weng-In, Kuok Un-I
Renal Department, Centro Hospitalar Conde de São Januário, Macao SAR, China.
Perit Dial Int. 2009 May-Jun;29(3):278-84.
To evaluate the safety and efficacy of inserting a straight-tip Tenckhoff catheter configured with a subcutaneous artificial swan neck.
Clinical outcomes of conventional swan-neck straight-tip catheters and Tenckhoff straight-tip catheters implanted with an artificial subcutaneous swan neck were compared in a prospective randomized controlled trial in a single-center setting.
Patients undergoing peritoneal dialysis catheter insertion were randomized to receive either a double-cuff straight-tip Tenckhoff catheter with an artificial subcutaneous swan-neck (TC) or a conventional double-cuff straight-tip swan-neck catheter (SN). The primary outcome was catheter exit-site infection rate; the secondary outcomes were catheter-related mechanical events and surgery-related bleeding.
A total of 39 consecutive patients were enrolled: 20 into the TC group and 19 into the SN group. More exit-site infections were observed in the SN group than in the TC group, although the difference was not statistically significant (0.97 vs 0.51 episodes per patient-year, p = 0.0657). However, there were more peritonitis episodes in the TC group than in the SN group (0.35 vs 0.15 episodes per patient-year, p = 0.0256). Exit-site and main wound bleeding post surgery were generally mild and similar in the 2 groups. No events of dialysate leakage, catheter tip migration, or subcutaneous cuff protrusion were observed in patients of either group. Outflow failure due to mechanical causes occurred in 2 patients in the TC group and in 1 patient in the SN group during the intermittent peritoneal dialysis period; all were corrected successfully by laparoscopic omentectomy.
Placement of the double-cuff straight-tip Tenckhoff catheter configured with an artificial subcutaneous swan neck appears to be an effective and safe procedure. It may be a good alternative to the conventional swan-neck catheter.
评估植入皮下人工鹅颈的直型Tenckhoff导管的安全性和有效性。
在单中心前瞻性随机对照试验中，比较传统鹅颈直型导管和植入皮下人工鹅颈的Tenckhoff直型导管的临床结局。
接受腹膜透析导管植入的患者被随机分为两组，分别接受带人工皮下鹅颈的双套囊直型Tenckhoff导管（TC组）或传统双套囊直型鹅颈导管（SN组）。主要结局是导管出口部位感染率；次要结局是导管相关机械事件和手术相关出血。
共纳入39例连续患者，其中20例进入TC组，19例进入SN组。SN组的出口部位感染比TC组更多，尽管差异无统计学意义（每位患者每年0.97次 vs 0.51次，p = 0.0657）。然而，TC组的腹膜炎发作比SN组更多（每位患者每年0.35次 vs 0.15次，p = 0.0256）。两组术后出口部位和主要伤口出血一般较轻且相似。两组患者均未观察到透析液渗漏、导管尖端移位或皮下套囊突出事件。在间歇性腹膜透析期间，TC组有2例患者、SN组有1例患者因机械原因发生流出道失败；所有患者均通过腹腔镜网膜切除术成功纠正。
植入皮下人工鹅颈的双套囊直型Tenckhoff导管似乎是一种有效且安全的手术。它可能是传统鹅颈导管的良好替代方案。
