Czyzewska Krystyna, Grzelak Teresa, Szary Beata
Zakład Biologii Chorób Cywilizacyjnych Katedry Chemii i Biochemii Klinicznej Uniwersytetu Medycznego im. Karola Marcinkowskiego w Poznaniu.
Przegl Lek. 2009;66(9):519-24.
This paper specifies the peritoneal dialysis problems as a method of renal replacement therapy in a historical perspective. It pointed out to the dynamic development of peritoneal dialysis in the nineties and distinct slump of the presented treatment form at the turn of XXth and XXIst century, despite substantial progress in the dialysis techniques, effectiveness and biocompatibility of the therapy as well as a detailed evaluation of peritoneal function in vivo and in vitro. It showed descriptions and outline of the peritoneal cavity dating from ancient times, 19th-century animal experiments determining essential laws of peritoneal absorption and removal molecules, as well as the first peritoneal dialysis of a man which took place at the beginning of the 20th-century. The technical problems and peritonitis were the fundamental limitations of this therapy employment in this phase of dialysis development. The application of Tenckhoffs catheter and the technique specified as continuous ambulatory peritoneal dialysis was the invention and at the same time, the turning point which decided about the considerable progress of the described method of dialysis in the nineties. In this period, the analyses concerning failures of the peritoneal transport functions and protection of peritoneum during its long-term use as a dialysis membrane dominated. These studies referred to not absolutely biocompatibility factors of the environment of the peritoneal cavity during peritoneal dialysis. Thence, proposed future directions of analyses include researches concerning components of dialysis solution to assure long-term preservation of peritoneal transport functions and its secretory properties. It is not excluded that experiments of applying the newest achievements of regenerative medicine, in the scope of genetic modification and implantation of mesothelial cells will be continued.
本文从历史角度详述了作为一种肾脏替代治疗方法的腹膜透析问题。它指出了20世纪90年代腹膜透析的动态发展，以及在20世纪末和21世纪初这种治疗形式明显的衰退，尽管透析技术、治疗的有效性和生物相容性取得了实质性进展，以及对体内和体外腹膜功能进行了详细评估。它展示了可追溯到古代的腹膜腔描述和概述、19世纪确定腹膜吸收和清除分子基本规律的动物实验，以及20世纪初进行的首例人体腹膜透析。技术问题和腹膜炎是透析发展这一阶段该治疗方法应用的根本限制。Tenckhoff导管的应用以及被称为持续性非卧床腹膜透析的技术是一项发明，同时也是决定所述透析方法在90年代取得显著进展的转折点。在这一时期，关于腹膜转运功能衰竭以及在长期将腹膜用作透析膜期间对腹膜的保护的分析占主导地位。这些研究涉及腹膜透析期间腹膜腔环境并非绝对的生物相容性因素。因此，提出的未来分析方向包括对透析液成分的研究，以确保长期维持腹膜转运功能及其分泌特性。不排除在基因改造和间皮细胞植入的再生医学最新成果应用方面的实验将继续进行。
