Cancarini G C, Manili L, Brunori G, Camerini C, Zubani R, Colombrita D, Pezzola D, Maiorca R
Chair of Nephrology, University of Brescia, Italy.
Adv Perit Dial. 1994;10:210-3.
The aim of this study was to verify whether the replacement of the peritoneal catheter in a single operation and during infectious complications of peritoneal dialysis is effective and safe. Sixty-eight infectious complications refractory to appropriate antibiotic therapy were treated by this technique: 26 tunnel infections, 22 peritonitis-complicating tunnel infections, 12 refractory peritonitis, and 8 recurrent peritonitis. Operations were successful in all cases of tunnel infection and recurring peritonitis, and in all cases but one of peritonitis-complicating tunnel infection. Ten failures occurred among the 12 catheters removed for refractory peritonitis. Microorganisms cultured in these 10 failures were: Fungi (3 cases), Mycobacterium (2 cases), Pseudomonas (2 cases), Acinetobacter (1 case), Acinetobacter+Pseudomonas (1 case), and Enterococcus (1 case). Complications were 3 one-way obstructions and 2 external dialysate leaks. This study supports the simultaneous catheter replacement-removal procedure during infectious complications of peritoneal dialysis (PD) with the exception of refractory peritonitis; this technique spares the patient the temporary vascular access, the shift to hemodialysis, and a second operation to insert a new catheter. There are few complications.
本研究的目的是验证在单次手术中以及在腹膜透析感染并发症期间更换腹膜导管是否有效且安全。采用该技术治疗了68例经适当抗生素治疗无效的感染并发症：26例隧道感染、22例并发隧道感染的腹膜炎、12例难治性腹膜炎和8例复发性腹膜炎。隧道感染和复发性腹膜炎的所有病例手术均成功，并发隧道感染的腹膜炎除1例以外的所有病例手术也成功。因难治性腹膜炎而拔除的12根导管中有10例失败。这10例失败病例培养出的微生物为：真菌（3例）、分枝杆菌（2例）、铜绿假单胞菌（2例）、不动杆菌（1例）、不动杆菌+铜绿假单胞菌（1例）和肠球菌（1例）。并发症有3例单向梗阻和2例外部透析液渗漏。本研究支持在腹膜透析（PD）感染并发症期间（难治性腹膜炎除外）同时进行导管更换-拔除 procedure；该技术使患者无需临时血管通路、无需转为血液透析以及无需二次手术插入新导管。并发症很少。
