Yamahatsu Aya, Hamada Chieko, Kaneko Kayo, Io Hiroaki, Nakata Junichiro, Tomino Yasuhiko
Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Clin Exp Nephrol. 2015 Oct;19(5):961-7. doi: 10.1007/s10157-015-1081-7. Epub 2015 Jan 23.
Encapsulating peritoneal sclerosis (EPS) is the most serious complication of peritoneal dialysis (PD) with a high mortality rate. The objective of the present study was to determine the clinical characteristics, the incidence rate, and the long-term outcome of EPS patients compared with control patients.
Two hundred and seventy patients with end-stage kidney disease were started on PD from 1987 to 2013 in the Juntendo University Hospital. EPS was diagnosed by clinical findings, radiological findings, and macroscopic inspection at the time of laparoscopy or surgical operation. Patient medical records were analyzed retrospectively, including clinical characteristics, laboratory findings, treatment modality, and outcomes. Using a Kaplan-Meier analysis, we compared the survival rate between EPS patients and control PD patients, matched for age, gender, diabetes, and duration of PD.
Among 270 PD patients, 13 patients (4.8 %) developed EPS. The mean duration of PD was 120.5 ± 42.8 months. There were no significant difference in demographic findings between EPS and control PD patients. Among the EPS patients, seven patients died, of which four deaths were directly attributed to EPS. All four patients that had had surgical enterolysis were doing well and had no recurrences. No significant difference in the survival rate between EPS and control PD patients was observed in the Kaplan-Meier analysis.
There was no significant difference in the survival rate between EPS patients and control PD patients. It appears that an early diagnosis by laparoscopy and accurate treatment, including surgical enterolysis, might improve mortality.
包裹性腹膜硬化（EPS）是腹膜透析（PD）最严重的并发症，死亡率很高。本研究的目的是确定EPS患者与对照患者相比的临床特征、发病率和长期预后。
1987年至2013年期间，270例终末期肾病患者在顺天堂大学医院开始接受腹膜透析治疗。通过临床检查结果、影像学检查结果以及腹腔镜检查或手术时的宏观检查来诊断EPS。对患者的病历进行回顾性分析，包括临床特征、实验室检查结果、治疗方式和预后。使用Kaplan-Meier分析，我们比较了年龄、性别、糖尿病和腹膜透析时间相匹配的EPS患者和对照腹膜透析患者的生存率。
在270例腹膜透析患者中，13例（4.8%）发生了EPS。腹膜透析的平均时间为120.5±42.8个月。EPS患者和对照腹膜透析患者在人口统计学结果方面没有显著差异。在EPS患者中，7例死亡，其中4例死亡直接归因于EPS。所有接受手术肠粘连松解术的4例患者情况良好，没有复发。在Kaplan-Meier分析中，未观察到EPS患者和对照腹膜透析患者在生存率上有显著差异。
EPS患者和对照腹膜透析患者在生存率上没有显著差异。似乎通过腹腔镜早期诊断并进行准确治疗，包括手术肠粘连松解术，可能会改善死亡率。
