Singapore General Hospital, Singapore.
Perit Dial Int. 2022 Nov;42(6):591-601. doi: 10.1177/08968608221116689. Epub 2022 Aug 9.
Peritoneal dialysis catheter (PDC)-related infections account for significant morbidity, PD disruptions and costs. Patients with refractory exit-site or tunnel track infections without peritonitis may need catheter removal and reinsertion which can be complicated by bleeding, organ injury, catheter failure or malposition. Some patients may need to switch to haemodialysis in such a setting. An alternative is a salvage procedure. The purpose of this systematic review is to evaluate the safety and efficacy of salvage techniques.
A comprehensive search of PubMed, Medline and Scopus databases was performed from inception to December 2021 in accordance with PRISMA guidelines. After a broad search, articles were stratified into two main categories for assessment: (1) cuff-shaving (CS) techniques and its variations of en-bloc resection (BR) and/or catheter diversion (CD) and (2) partial reimplantation with CD.
A total of 409 patients (445 salvage procedures) from 20 studies were included in analysis. Of 409 patients, 234 patients (57.2%) underwent 251 (56.4%) CS procedures and its variations, 163 patients (39.9%) underwent 182 (40.9%) partial PDC reimplantations with CD and 12 patients (2.7%) underwent local curettage. Overall PDC salvage rate after intervention was 73.2%. Overall PDC removal rate attributable to infection was 26.8%. Overall complication rate attributable to the procedures was 2.7%, with the most common complication being dialysate leakage ( = 10) followed by PDC laceration ( = 1) and subcutaneous haematoma ( = 1). We also included a description of our technique of BR of infected tissue, CS and CD. In a series of six patients, the PDC salvage rate was 83.3% and median PDC survival after intervention was 10 months.
PDC salvage techniques are relatively safe and provide reasonable catheter salvage rates in selected patients. Results of this review should lend weight to consideration of a salvage-first approach as an option in selected patients.
腹膜透析导管（PDC）相关感染会导致较高的发病率、PD 中断和费用。对于没有腹膜炎的难治性出口部位或隧道-track 感染患者，可能需要拔除和重新插入导管，这可能会导致出血、器官损伤、导管失败或错位等并发症。在这种情况下，一些患者可能需要切换到血液透析。另一种选择是挽救性手术。本系统评价的目的是评估挽救技术的安全性和有效性。
根据 PRISMA 指南，从成立到 2021 年 12 月，对 PubMed、Medline 和 Scopus 数据库进行了全面搜索。经过广泛搜索，文章被分为两个主要评估类别：（1）套袖削除（CS）技术及其整块切除（BR）和/或导管分流（CD）的变化，以及（2）带 CD 的部分重新植入。
共有 20 项研究的 409 名患者（445 例挽救性手术）纳入分析。在 409 名患者中，234 名患者（57.2%）接受了 251 例（56.4%）CS 手术及其变化，163 名患者（39.9%）接受了 182 例（40.9%）带 CD 的部分 PDC 重新植入，12 名患者（2.7%）接受了局部刮除术。干预后的总体 PDC 挽救率为 73.2%。因感染而导致的总体 PDC 拔除率为 26.8%。归因于该手术的总体并发症发生率为 2.7%，最常见的并发症是透析液渗漏（=10），其次是 PDC 撕裂（=1）和皮下血肿（=1）。我们还描述了我们的受感染组织整块切除、CS 和 CD 的技术。在一组 6 例患者中，PDC 挽救率为 83.3%，干预后 PDC 中位存活时间为 10 个月。
PDC 挽救技术相对安全，在选择的患者中提供了合理的导管挽救率。本综述的结果应该为在选择的患者中考虑挽救优先方法提供依据。
