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腹膜炎复发时 PD 导管的同时拔出和再插入。

Simultaneous Removal And Reinsertion of the PD Catheter in Relapsing Peritonitis.

机构信息

CHU de Caen, Department of Nephrology - Dialysis - Transplantation, Caen, France.

CHU de Caen, Department of Nephrology - Dialysis - Transplantation, Caen, France

出版信息

Perit Dial Int. 2019 May-Jun;39(3):282-288. doi: 10.3747/pdi.2018.00230. Epub 2019 Mar 9.

Abstract

Relapsing peritonitis in peritoneal dialysis (PD) is associated with lower cure rates and more hemodialysis (HD) transfers, as catheter removal is recommended in these situations. The aim of our study was to evaluate the continuation of PD without perioperative transfer to HD in patients who underwent a simultaneous catheter removal and replacement for relapsing peritonitis.This was a retrospective monocentric study. Patients with simultaneous catheter removal and replacement for relapsing peritonitis or peritonitis at high risk of relapse (fungal or infection) between 1 January 2007 and 31 December 2016 were included. The events of interest were the continuation of PD without perioperative transfer to HD, postoperative complications, new infection with the same organism, and technique survival.Of the 271 incident patients in PD during this period, 11 had a simultaneous catheter removal and replacement for relapsing peritonitis (8) or high risk of relapse peritonitis (3). Eight (72.7%) patients pursued PD without transfer to HD. Six infections were due to microorganisms other than gram-positive cocci. At 1 year, 7 (63.6%) of the 11 patients were still on PD. After the surgery, there were no peritonitis or catheter-related infections caused by the same organism.Simultaneous catheter removal and replacement for peritonitis appears to be an effective procedure for maintaining patients on PD.

摘要

复发腹膜炎与腹膜透析(PD)相关,其治愈率较低,且更易转为血液透析(HD),因为在这种情况下建议去除导管。本研究旨在评估对同时进行导管去除和更换以治疗复发腹膜炎的患者,在不进行围手术期 HD 转治的情况下继续 PD 治疗。

这是一项回顾性单中心研究。纳入 2007 年 1 月 1 日至 2016 年 12 月 31 日期间因复发腹膜炎(真菌或 感染)或腹膜炎复发高危(革兰阳性球菌)而同时进行导管去除和更换的患者。主要研究终点为不进行围手术期 HD 转治而继续 PD 治疗、术后并发症、同一病原体的新发感染和技术生存率。

在该时期接受 PD 治疗的 271 例首发患者中,11 例因复发腹膜炎(8 例)或腹膜炎复发高危(3 例)而同时进行导管去除和更换。8 例(72.7%)患者未转为 HD 而继续 PD 治疗。6 例感染由除革兰阳性球菌外的微生物引起。1 年后,11 例患者中有 7 例(63.6%)仍在继续 PD 治疗。手术后,无同一病原体引起的腹膜炎或导管相关感染。

同时进行导管去除和更换治疗腹膜炎似乎是维持 PD 患者治疗的有效方法。

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