Mihalache O, Bugă C, Doran H, Catrina E, Bobircă F, Andreescu A, Mustățea P, Pătrașcu T
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
"I. Juvara" Surgical Clinic, "Dr. I. Cantacuzino" Clinical Hospital, Bucharest, Romania.
J Med Life. 2016 Jul-Sep;9(3):284-287.
Peritonitis is the main complication of peritoneal dialysis (PD) and also an important factor for raising the cost of the method to the level of hemodialysis. Associated with PD, peritonitis is responsible for the increase of morbidity and mortality of the procedure and, at the same time, the main cause of the technique failure. Severe and prolonged peritonitis or repeated episodes of peritonitis lead to ultrafiltration failure. Peritonitis treatment should aim for a rapid remission of inflammation in order to preserve the peritoneal membrane functional integrity. The treatment of PD peritonitis consists mainly of antibiotic therapy, surgical intervention not being usually required. However, it is of outmost importance to differentiate the so-called "catheter related" peritonitis from secondary peritonitis due to visceral lesions, in which the surgical treatment comes first. The confusion between secondary and "catheter related" peritonitis may lead to serious errors in choosing the correct treatment, endangering the patient's life. The differential diagnosis between a refractory or secondary peritonitis in a peritoneal dialyzed patient may be very difficult. In front of a refractory PD peritonitis, surgical exploration must not be delayed. Also we have to keep in mind that the aim of peritonitis treatment is the saving of the peritoneal membrane and not the catheter.
腹膜炎是腹膜透析（PD）的主要并发症，也是导致该治疗方法成本上升至血液透析水平的重要因素。与腹膜透析相关，腹膜炎会导致该治疗的发病率和死亡率上升，同时也是技术失败的主要原因。严重且持续时间长的腹膜炎或反复发生的腹膜炎会导致超滤失败。腹膜炎的治疗应以迅速缓解炎症为目标，以保持腹膜的功能完整性。腹膜透析相关性腹膜炎的治疗主要包括抗生素治疗，通常不需要手术干预。然而，将所谓的“导管相关性”腹膜炎与因内脏病变引起的继发性腹膜炎区分开来至关重要，后者需首先进行手术治疗。继发性腹膜炎与“导管相关性”腹膜炎之间的混淆可能导致在选择正确治疗方法时出现严重错误，危及患者生命。腹膜透析患者难治性或继发性腹膜炎的鉴别诊断可能非常困难。面对难治性腹膜透析相关性腹膜炎，不得延迟手术探查。我们还必须牢记，腹膜炎治疗的目的是挽救腹膜，而不是导管。
