Nelson H, Lindner M, Schuman E S, Gross G F, Hayes J F
Surg Gynecol Obstet. 1983 Dec;157(6):541-4.
Home peritoneal dialysis has recently become an important addition to the therapy of chronic renal failure. Abdominal wall hernias have become more apparent as complications of this mode of dialysis, with isolated instances of incarcerations and one fatality. Results of our review of 276 patients receiving peritoneal dialysis revealed seven with hernias, an incidence of 2.5 per cent. Six patients with hernias were receiving c.a.p.d.; one patient was receiving c.c.p.d., and none was receiving i.p.d., for incidences of 17, 5 and zero per cent, respectively. All hernias found at presentation occurred within two to 20 months after peritoneal catheter placement. Most were ventral or umbilical, and all were repaired electively without serious complications. All patients with hernias had associated problems with leaks, peritonitis or predialysis hernias. In two of four patients with predialysis hernias, herniorrhaphy without catheter removal resulted in two recurrences. Abdominal wall hernias are a more frequent complication of c.a.p.d. and c.c.p.d., modalities which require large volumes of peritoneal dialysate during ambulatory hours. Review of the literature reveals that wound tensile strength and healing are decreased in those patients having renal disease with uremia, anemia and malnutrition. However, these factors do not increase the over-all incidence of hernias. Patients should be screened for hernias, and hernias should be repaired prior to catheter placement. Hernias presenting during dialysis are best treated by herniorrhaphy and hemodialysis postoperatively or low volume peritoneal dialysis to optimize the metabolic state.
家庭腹膜透析最近已成为慢性肾衰竭治疗的一项重要补充。腹壁疝作为这种透析方式的并发症已变得更加明显，有个别嵌顿病例和一例死亡病例。我们对276例接受腹膜透析的患者进行回顾的结果显示，有7例发生疝，发生率为2.5%。6例疝患者接受持续性非卧床腹膜透析（CAPD）；1例接受持续性循环腹膜透析（CCPD），无患者接受间歇性腹膜透析（IPD），发生率分别为17%、5%和0%。所有在就诊时发现的疝均发生在腹膜置管后2至20个月内。大多数为腹侧或脐部疝，均择期修复且无严重并发症。所有疝患者均伴有渗漏、腹膜炎或透析前疝等相关问题。在4例透析前疝患者中的2例中，未拔除导管进行疝修补导致2例复发。腹壁疝是CAPD和CCPD更常见的并发症，这两种透析方式在非卧床时间需要大量腹膜透析液。文献回顾显示，患有肾病伴尿毒症、贫血和营养不良的患者伤口抗张强度和愈合能力下降。然而，这些因素并不会增加疝的总体发生率。应对患者进行疝筛查，并且应在置管前修复疝。透析期间出现的疝最好在术后通过疝修补术和血液透析或小容量腹膜透析进行治疗，以优化代谢状态。
