Yan Hao, Bian Zhengqian, Zhang Weiming, Fang Yan, Che Miaolin, Fang Wei
Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Gastric and Intestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Case Rep Nephrol Dial. 2015 Mar 4;5(1):66-70. doi: 10.1159/000379743. eCollection 2015 Jan-Apr.
Peritonitis is the most common infection in peritoneal dialysis (PD) and has been noted to be not only a cause of mortality but also the leading cause of technique failure in patients maintained on PD. Appropriate management of peritonitis to improve patient outcome has been the focus of clinical practice. We report a case of refractory PD-related peritonitis with surgical intervention intending to control ongoing peritoneal infection despite aggressive antibiotics and timely catheter removal. Exploratory laparotomy was performed in this case, and an encapsulated abscess in the peritoneal and pelvic cavity was obliterated. Adhesiolysis was done simultaneously. Continuous postoperative peritoneal lavage and drainage were implemented. Symptoms dramatically improved after operation, and indwelling tubes were removed several days later. Finally, the patient recovered and switched to permanent hemodialysis without intra-abdominal complications. Our case suggested that appropriate and timely surgical intervention in refractory peritonitis is necessary for saving lives in certain subgroups of patients. Clearly, well-designed studies with large samples are warranted to explore this issue in more detail.
腹膜炎是腹膜透析（PD）中最常见的感染，不仅是导致死亡的原因，也是接受PD治疗患者技术失败的主要原因。恰当处理腹膜炎以改善患者预后一直是临床实践的重点。我们报告一例难治性PD相关性腹膜炎病例，尽管使用了强效抗生素并及时拔除导管，但仍通过手术干预来控制持续的腹膜感染。该病例进行了剖腹探查，清除了腹膜和盆腔内的包裹性脓肿，并同时进行了粘连松解术。术后持续进行腹膜灌洗和引流。术后症状显著改善，数天后拔除留置管。最后，患者康复并转为永久性血液透析，未出现腹腔内并发症。我们的病例表明，对于某些亚组患者，在难治性腹膜炎中进行恰当及时的手术干预对于挽救生命是必要的。显然，需要开展设计良好的大样本研究以更详细地探讨这一问题。
