Bayraktar Adem, Gök Ali Fuat Kaan, Emiroğlu Selman, Bakkaloğlu Hüseyin
Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey.
Ulus Travma Acil Cerrahi Derg. 2019 Mar;25(2):142-146. doi: 10.14744/tjtes.2019.04838.
Encapsulating peritoneal sclerosis (EPS) related to peritoneal dialysis (PD) has a vague etiology and high mortality. In this study, our aim was to determine treatment options for EPS cases.
A total of 169 patients underwent kidney transplantation from January 2008 to January 2018 and 119 patients from a cadaveric and 50 patients from a living donor. Twenty-one patients were undergoing PD before the transplantation. The mean PD time was 6.9 (IQR 3-14) years. Four patients received surgical treatment for EPS that occurred after the transplant. After the surgical treatment, 2 patients died because of sepsis. Two patients were discharged without complications, but 1 had late-term EPS recurrence.
EPS is a rare but serious complication of long-term PD. It has a high mortality and morbidity rate. Long-term PD is the most significant factor for triggering EPS. Nutritional support and surgical intervention is the next step if medical treatment fails. Resistant cases should be treated surgically without much delay before the condition deteriorates.
It can be especially devastating for patients with a long-term PD history to have EPS after a successful transplant. Because EPS is a challenging condition, its management should be done in experienced clinics to decrease its mortality and morbidity rates.
与腹膜透析（PD）相关的包裹性腹膜硬化（EPS）病因不明且死亡率高。在本研究中，我们的目的是确定EPS病例的治疗方案。
2008年1月至2018年1月，共有169例患者接受了肾移植，其中119例接受尸体供肾移植，50例接受活体供肾移植。21例患者在移植前接受腹膜透析。腹膜透析平均时间为6.9（四分位间距3 - 14）年。4例患者在移植后因EPS接受了手术治疗。手术治疗后，2例患者因败血症死亡。2例患者出院时无并发症，但1例出现晚期EPS复发。
EPS是长期腹膜透析罕见但严重的并发症。其死亡率和发病率很高。长期腹膜透析是引发EPS的最重要因素。如果药物治疗失败，营养支持和手术干预是下一步措施。对于耐药病例，应在病情恶化前尽快进行手术治疗。
对于有长期腹膜透析史的患者，成功移植后发生EPS可能具有特别大的破坏性。由于EPS是一种具有挑战性的病症，其管理应在经验丰富的诊所进行，以降低其死亡率和发病率。
