Mihalache O, Doran H, Catrina E, Bobircă F, Mustatea P, Georgescu D, Pătrașcu T
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania ; Surgical Clinic I, "Juvara" Clinical Hospital; "Dr. I. Cantacuzino" Hospital, Bucharest, Romania.
J Med Life. 2014;7 Spec No. 3(Spec Iss 3):103-6.
The infectious syndrome associated with peritoneal dialysis is the most important complication of this substitution method of the renal function, also being the main cause of method failure. Refractory peritonitis can cause real problems in the differential diagnosis with secondary peritonitis, which can delay the surgical intervention and endanger the patient's life.
The patients with an end stage renal disease under peritoneal dialysis, who were admitted to "I. Juvara" Surgical Clinic of "Dr. I. Cantacuzino" Clinical Hospital, between 2007 and 2011, were retrospectively analyzed for catheter removal/ replacement due to infectious complications or ultrafiltration failure.
55 patients were identified: 33 with infectious complications (exit-site, tunnel infections 4 and peritonitis 29) and 22 with loss of peritoneum ultrafiltration capacity. The patients with ultrafiltration failure had a longer duration of PD and a smaller number of peritonitic episodes (0.28 episodes/ year at risk in the ultrafiltration failure group vs. 0.98, in the group of infectious complications). The removal of the catheter was the only surgical procedure performed for the patients with ultrafiltration failure, while the patients with peritonitis needed additional gestures like an exploratory laparotomy with peritoneal lavage and drainage and adhesiolysis in the majority of cases. In the group with infectious complications, 4 patients died: 2 by multisystem organ failure due to prolonged sepsis, one developed an upper gastrointestinal bleeding followed by respiratory insufficiency and one had in cataclysmic gastrointestinal bleeding which rapidly led to death.
The immediate operative approach for an infectious peritoneal syndrome under peritoneal dialysis is seldom necessary. The surgical observation is absolutely mandatory in every case. The absence of a response to the proper medical treatment is an indication of peritoneal cavity exploration including laparoscopy/ laparotomy. Any delay in the diagnosis and definitive treatment gives an extremely high mortality rate.
与腹膜透析相关的感染综合征是这种肾功能替代方法最重要的并发症，也是导致该方法失败的主要原因。难治性腹膜炎在与继发性腹膜炎的鉴别诊断中会引发实际问题，可能延误手术干预并危及患者生命。
对2007年至2011年间入住“Dr. I. Cantacuzino”临床医院“I. Juvara”外科诊所、接受腹膜透析的终末期肾病患者进行回顾性分析，以了解因感染并发症或超滤失败而进行导管拔除/更换的情况。
共确定55例患者：33例有感染并发症（出口处感染、隧道感染4例，腹膜炎29例），22例有腹膜超滤能力丧失。超滤失败的患者腹膜透析时间更长，腹膜炎发作次数更少（超滤失败组每年风险发作0.28次，感染并发症组为0.98次）。对于超滤失败的患者，拔除导管是唯一进行的外科手术，而大多数腹膜炎患者还需要额外的操作，如剖腹探查、腹膜灌洗引流和粘连松解。在感染并发症组中，4例患者死亡：2例因长期败血症导致多系统器官衰竭死亡，1例出现上消化道出血继而呼吸功能不全死亡，1例发生灾难性胃肠道出血并迅速导致死亡。
腹膜透析下感染性腹膜综合征很少需要立即进行手术治疗。每种情况都绝对必须进行外科观察。对适当药物治疗无反应是进行包括腹腔镜检查/剖腹探查在内的腹腔探查的指征。诊断和确定性治疗的任何延迟都会导致极高的死亡率。
