Division of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Clinical Sciences and Community Health, Università degli studi di Milano, Milan, Italy.
Int Urol Nephrol. 2023 Jan;55(1):151-155. doi: 10.1007/s11255-022-03288-0. Epub 2022 Jul 11.
In tunnel infection (TI) refractory to medical therapy or in case of TI that occurs simultaneously with peritonitis, the removal of the peritoneal catheter has been proposed. This approach requires the interruption of peritoneal dialysis (PD) and the creation of a temporary vascular access. However, simultaneous removal and reinsertion of the PD catheter (SCR) represents another possible therapeutic approach.
We analysed the outcome of 20 patients (10 men and 10 women, mean age 65.5 ± 16.3 years) treated by CAPD for a mean period of 24.3 ± 14.2 months who underwent to SCR for the treatment of TI unresponsive to medical therapy or TI that occurred simultaneously with peritonitis at Fondazione Ca' Granda Ospedale Maggiore Policlinico. All the patients restarted CAPD exchanges within 24 h from catheter placement.
SCR was successful in 80% (16/20) of the cases. In particular, SCR was effective in 100% (11/11) of the TI with or without associated peritonitis sustained by S. aureus. However, SCR failed in 57% (4/7) of TI associated with relapsing peritonitis and in one patient with TI secondary to Enterobacter. No early mechanical complications (within 3 months after SCR) occurred when CAPD was restarted.
SCR of the PD catheter through double-purse string technique represents an effective treatment for TI without or with simultaneously peritonitis sustained by S. aureus avoiding the patient the need for temporary hemodialysis and second surgical procedure. However, SCR could be contraindicated in case of relapsing peritonitis.
在药物治疗无效的隧道感染（TI）或 TI 同时并发腹膜炎的情况下，已提出移除腹膜导管。这种方法需要中断腹膜透析（PD）并建立临时血管通路。然而，PD 导管的同时移除和重新插入（SCR）代表了另一种可能的治疗方法。
我们分析了在 Fondazione Ca' Granda Ospedale Maggiore Policlinico 接受 CAPD 治疗的 20 名患者（10 名男性和 10 名女性，平均年龄 65.5±16.3 岁）的治疗结果，这些患者因药物治疗无效的 TI 或同时并发腹膜炎而行 SCR 治疗，这些患者接受 CAPD 治疗的平均时间为 24.3±14.2 个月。所有患者均在导管放置后 24 小时内重新开始 CAPD 交换。
SCR 在 80%（16/20）的病例中成功。特别是，SCR 在由金黄色葡萄球菌引起的伴有或不伴有相关腹膜炎的 TI 中 100%（11/11）有效。然而，SCR 在 57%（4/7）的与复发性腹膜炎相关的 TI 和一例由肠杆菌引起的 TI 中失败。当重新开始 CAPD 时，没有发生早期机械并发症（SCR 后 3 个月内）。
通过双荷包缝线技术进行 PD 导管的 SCR 是一种有效的治疗方法，适用于由金黄色葡萄球菌引起的无或伴有腹膜炎的 TI，避免了患者需要临时血液透析和第二次手术。然而，在复发性腹膜炎的情况下，SCR 可能是禁忌的。
