Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente Downey Medical Center, Downey, California, USA.
Perit Dial Int. 2010 Jan-Feb;30(1):46-55. doi: 10.3747/pdi.2009.00004.
An alternative peritoneal catheter exit-site location is sometimes needed in patients with obesity, floppy skin folds, intestinal stomas, urinary and fecal incontinence, and chronic yeast intertrigo. Two-piece extended catheters permit remote exit-site locations away from problematic abdominal conditions.
The effect on clinical outcomes by remotely locating catheter exit sites to the upper abdomen or chest was compared to conventional lower abdominal sites.
In a nonrandomized design, peritoneal access was established with 158 extended catheters and 270 conventional catheters based upon body habitus and special clinical needs. Prospective data collection included patient demographics, infectious and mechanical complications, and catheter survival.
Kaplan-Meier survival time until first exit-site infection was longer for extended catheters (p = 0.03). Poisson regression showed no difference in exit site, subcutaneous tunnel, and peritonitis infection rates; however, the proportion of catheters lost during peritonitis episodes was significantly greater for extended catheters (p = 0.007) and appeared to be due primarily to coagulase-negative staphylococcus organisms. Poisson regression showed interactions of body mass index (BMI) and diabetic status in determining catheter loss from peritonitis for both catheter types (p = 0.02). Extended catheter patients had higher BMI and diabetes prevalence (p < 0.0001). Overall extended catheter survival at 1, 2, and 3 years (92%, 80%, 71%) trended lower than conventional devices (93%, 87%, 80%; p = 0.0505).
Extended catheters enable peritoneal access for patients in whom conventional catheter placement would be difficult or impossible. Certain patient and extended-catheter characteristics may contribute to loss from peritonitis.
在肥胖、皮肤松弛、肠造口、尿便失禁和慢性酵母间擦疹患者中，有时需要替代腹膜导管出口部位。两件式延长导管允许将导管出口部位远程放置在远离腹部问题的位置。
将导管出口部位远程放置在上腹部或胸部与常规下腹部部位相比，对临床结果的影响。
在非随机设计中，根据体型和特殊临床需求，使用 158 根延长导管和 270 根常规导管建立腹膜通路。前瞻性数据收集包括患者人口统计学、感染和机械并发症以及导管存活率。
Kaplan-Meier 生存时间直到首次出现出口部位感染，延长导管更长（p = 0.03）。泊松回归显示，出口部位、皮下隧道和腹膜炎感染率无差异；然而，延长导管腹膜炎发作期间丢失的导管比例明显更高（p = 0.007），这似乎主要是由于凝固酶阴性葡萄球菌。泊松回归显示，BMI 和糖尿病状态在两种导管类型的腹膜炎导致导管丢失方面存在相互作用（p = 0.02）。延长导管患者的 BMI 和糖尿病患病率更高（p < 0.0001）。1、2、3 年的总体延长导管存活率（92%、80%、71%）低于常规导管（93%、87%、80%；p = 0.0505）。
延长导管使常规导管放置困难或不可能的患者能够进行腹膜通路。某些患者和延长导管的特征可能导致腹膜炎丢失。
