Lo W K, Chan K T, Leung A C, Pang S W, Tse C Y
Department of Medicine, United Christian Hospital, Kwun Tong, Hong Kong.
Adv Perit Dial. 1990;6:79-84.
Sclerosing peritonitis (SP) is an uncommon but serious complication of CAPD with various suggested etiology. We have documented 14 cases of SP in 18 CAPD patients using chlorhexidine in alcohol (ChA) in the connection procedure; 13 died. Nine of the 14 patients had been transferred to haemodialysis or renal transplantation, yet all still developed symptoms of SP within a few months after transfer even though 5 of them were originally asymptomatic. The main symptoms of SP were peritoneal ultrafiltration failure, exudative bloody ascites and intestinal obstruction. They present at around 5 years (30-80 months) after commencement of CAPD. Four other patients with a comparable duration of ChA exposure were continued on CAPD with a Travenol Spike System (TSS) without further exposure to ChA. They were all asymptomatic of SP after 9-12 months. Comparing the 2 groups of asymptomatic patients at 9 months after transfer, those transferred to TSS have a much better outcome than those transferred to HD or renal transplantation (P = 0.0476). We concluded that ChA is the main cause of SP in our patients and continuing CAPD without further exposure to ChA is a better alternative than stopping CAPD in preventing the progression of SP.
硬化性腹膜炎（SP）是持续性非卧床腹膜透析（CAPD）一种罕见但严重的并发症，病因有多种推测。我们记录了18例在连接操作中使用酒精洗必泰（ChA）的CAPD患者中有14例发生SP；其中13例死亡。14例患者中有9例已转为血液透析或肾移植，但即便其中5例最初无症状，在转至血液透析或肾移植后的几个月内仍出现了SP症状。SP的主要症状为腹膜超滤功能衰竭、血性渗出性腹水和肠梗阻。这些症状在开始CAPD约5年（30 - 80个月）后出现。另外4例ChA暴露时间相当的患者继续使用Travenol Spike System（TSS）进行CAPD，未再接触ChA。9 - 12个月后他们均无SP症状。在转至血液透析或肾移植9个月后对两组无症状患者进行比较，转至TSS的患者比转至血液透析或肾移植的患者预后要好得多（P = 0.0476）。我们得出结论，ChA是我们患者发生SP的主要原因，在预防SP进展方面，继续进行CAPD且不再接触ChA比停止CAPD是更好的选择。
