Dr. Lee Iu Cheung Memorial Renal Research Centre, Tung Wah Hospital, Department of Medicine, The University of Hong Kong, Hong Kong, SAR.
Perit Dial Int. 2010 Jan-Feb;30(1):56-62. doi: 10.3747/pdi.2008.00240.
The downward directed exit of the swan neck catheter may decrease the risk of exit-site infection (ESI). The percentage of migrations of the swan neck catheter seems to be less than the conventional Tenckhoff catheter and the swan neck catheter is more expensive and cannot be manipulated by guidewire technique if tip migration occurs. In this study, the conventional Tenckhoff catheter was used. The straight tunnel was converted to an arcuate one using the triple incision method, resulting in a downward directed exit. The arcuate tunnel was created by passing the catheter through an additional incision located between the paramedian incision and the exit site. We compared the infective and mechanical complications of the Tenckhoff catheter with a downward exit, implanted using the triple incision method, with the swan neck catheter.
101 new peritoneal dialysis patients were prospectively randomized to receive either the Tenckhoff catheter with a downward exit, implanted using the triple incision method, or the swan neck catheter. Each patient was followed up for 24 months. 50 patients were in the triple incision method group (TIMG) and 51 were in the swan neck catheter group (SNCG).
Over a mean period of 18.9 +/- 8.0 months of follow-up, ESI occurred in 35 patients (70%) in TIMG and 37 patients (72.5%) in SNCG (p = 0.83). The ESI rates were 0.71 and 1.0 episodes/catheter-year in TIMG and SNCG respectively (p = 0.21). The peritonitis rates were similar in the 2 groups (0.64 episodes/year in TIMG and 0.68 episodes/year in SNCG, p = 0.47). More patients in TIMG had tip migration [15 patients (30%) in TIMG vs 10 patients (19.6%) in SNCG] but the difference was not statistically significant. Repositioning of the catheter by guidewire manipulation was successful in patients in TIMG but not in SNCG. Overall catheter survival at 12 and 24 months was 95% and 83% in TIMG and 93% and 79% in SNCG respectively (p = 0.72).
By using the conventional Tenckhoff catheter with a downward exit created using the triple incision method, high catheter survival rates with infective and mechanical complication rates similar to those of the swan neck catheter can be achieved. The triple incision method has the additional advantages of lower cost and the catheter can be manipulated by guidewire technique if tip migration occurs.
天鹅颈导管向下的出口可降低出口部位感染（ESI）的风险。天鹅颈导管的迁移百分比似乎低于传统的 Tenckhoff 导管，如果导管尖端迁移，天鹅颈导管更昂贵且无法通过导丝技术进行操作。在这项研究中，使用了传统的 Tenckhoff 导管。通过三重切口法将直隧道转换为弧形隧道，从而形成向下的出口。通过在旁正中切口和出口之间的另一个切口将导管穿过，从而创建了弧形隧道。我们比较了使用三重切口法植入的具有向下出口的 Tenckhoff 导管与天鹅颈导管的感染和机械并发症。
101 例新的腹膜透析患者前瞻性随机分为接受三重切口法植入的具有向下出口的 Tenckhoff 导管或天鹅颈导管。每位患者随访 24 个月。50 例患者在三重切口法组（TIMG），51 例患者在天鹅颈导管组（SNCG）。
在平均 18.9±8.0 个月的随访期间，TIMG 中有 35 例（70％）和 SNCG 中有 37 例（72.5％）患者发生 ESI（p=0.83）。TIMG 和 SNCG 的 ESI 发生率分别为 0.71 和 1.0 例/导管年（p=0.21）。两组腹膜炎发生率相似（TIMG 为 0.64 例/年，SNCG 为 0.68 例/年，p=0.47）。TIMG 中有更多的患者发生尖端迁移[TIMG 中有 15 例（30％），而 SNCG 中有 10 例（19.6％）]，但差异无统计学意义。TIMG 中的患者通过导丝操作成功地重新定位了导管，但 SNCG 中的患者则没有。TIMG 中 12 个月和 24 个月时的总体导管生存率分别为 95％和 83％，SNCG 中分别为 93％和 79％（p=0.72）。
使用三重切口法创建的具有向下出口的传统 Tenckhoff 导管，可获得与天鹅颈导管相似的高导管生存率和感染性及机械性并发症发生率。三重切口法具有成本较低和导管尖端迁移时可通过导丝技术进行操作的额外优势。
