Sinha S, Fok M, Davenport A, Banga N, Lindsey B, Fernando B, Forman C J
Royal Free London NHS Foundation Trust , UK.
Basildon and Thurrock University Hospitals NHS Foundation Trust , UK.
Ann R Coll Surg Engl. 2018 Sep;100(7):534-544. doi: 10.1308/rcsann.2018.0088. Epub 2018 Apr 25.
Introduction The use of embedded peritoneal dialysis (PD) catheters is purported to offer numerous benefits over standard placement. However, the optimum period of embedment and the effect of prolonged embedment on subsequent catheter function remain unclear. Methods This retrospective observational study looked at adult patients undergoing embedded PD catheter insertion in a large tertiary referral centre in the UK. Possible predictors for catheter non-function at externalisation were investigated. These included patient factors (age, sex, diabetic status, body mass index, ethnicity, smoking status, previous surgery, estimated glomerular filtration rate), procedural factors (modality of surgery, concurrent surgical procedure), duration of catheter embedment and catheter damage at externalisation. Outcomes examined were proportion of catheters functioning after externalisation, futile placement rate, surgical reintervention rate, infectious complication rate and proportion of externalised catheters lost owing to malfunction. Results Sixty-six catheters were embedded and two-thirds (n=47, 63.6%) were externalised after a median embedment period of 39.4 weeks. Of these, 25 (53.2%) functioned on externalisation. Fourteen (63.6%) of the 22 non-functioning catheters were salvaged. The overall utilisation of PD was 34/47 (72.3%) and the futile placement rate was 12.1%. Over half of the externalised catheters (n=27, 57.4%) were lost directly as a result of catheter related complications, with a median survival time of 39.4 weeks. In adjusted analysis, increasing embedment duration was significantly predictive of catheter non-function at externalisation (adjusted odds ratio: 0.957, 95% confidence interval [CI]: 0.929-0.985, p=0.003) while subsequent catheter loss was highly dependent on catheter function at externalisation (hazard ratio: 0.258, 95% CI: 0.112-0.594, p=0.001). Conclusions Prolonged embedment of PD catheters is associated with a significantly higher likelihood of catheter dysfunction following externalisation, which is in turn associated with subsequent catheter loss. We have discontinued the use of this technique in our unit.
引言 据称，与标准置管相比，使用嵌入式腹膜透析（PD）导管有诸多益处。然而，最佳嵌入期以及长期嵌入对后续导管功能的影响仍不明确。方法 这项回顾性观察研究观察了在英国一家大型三级转诊中心接受嵌入式PD导管插入术的成年患者。研究了导管外置时功能障碍的可能预测因素。这些因素包括患者因素（年龄、性别、糖尿病状态、体重指数、种族、吸烟状况、既往手术史、估计肾小球滤过率）、手术因素（手术方式、同期手术）、导管嵌入持续时间以及外置时导管损伤情况。所检查的结果包括外置后功能良好的导管比例、无效置管率、手术再次干预率、感染并发症发生率以及因功能障碍而丢失的外置导管比例。结果 共嵌入66根导管，中位嵌入期为39.4周后，三分之二（n = 47，63.6%）实现外置。其中，25根（53.2%）外置时功能良好。22根功能不良的导管中有14根（63.6%）得以挽救。PD的总体利用率为34/47（72.3%），无效置管率为12.1%。超过一半的外置导管（n = 27，57.4%）因与导管相关的并发症而直接丢失，中位生存时间为39.周。在多因素分析中，嵌入持续时间延长显著预测导管外置时功能障碍（调整后的优势比：0.957，95%置信区间[CI]：0.929 - 0.985，p = 0.003），而后续导管丢失高度依赖于外置时的导管功能（风险比：0.258，95% CI：0.112 - 0.594，p = 0.001）。结论 PD导管长期嵌入与外置后导管功能障碍的可能性显著升高相关，而这又与后续导管丢失相关。我们单位已停止使用该技术。
