Junor B J, McMillan M A
Renal Unit, Western Infirmary, Glasgow, United Kingdom.
Adv Perit Dial. 1993;9:187-9.
Sclerosing peritonitis (ScP) is a rare but fatal complication of continuous ambulatory peritoneal dialysis (CAPD), presenting as small bowel obstruction. We have observed that only patients receiving a renal transplant survived more than a few months after the diagnosis of ScP. We now report prolonged survival of patients given immunosuppressive therapy with or without a functioning transplant. ScP was found at laparotomy in 17 Glasgow patients, 15 of whom had been exposed to chlorhexidine in alcohol. All patients discontinued CAPD after diagnosis. Within a year 12 died with recurrent bowel obstruction; none received immunosuppressive therapy. The remaining 5 patients received immunosuppressive therapy; 4 are alive between 1 and 9 years later, and one patient with widespread vascular disease died after 3 years with mesenteric ischemia. Four of the 5 received a renal transplant. One patient rejected his transplant; when immunosuppression was stopped he developed symptoms suggestive of recurrent ScP. Immunosuppressive therapy was restarted and he remains well 3 years later. The fifth patient, who did not receive a transplant, was immunosuppressed after ScP was diagnosed. She remains well 18 months later. Our experience suggests that immunosuppression is beneficial in ScP.
硬化性腹膜炎（ScP）是持续性非卧床腹膜透析（CAPD）的一种罕见但致命的并发症，表现为小肠梗阻。我们观察到，只有接受肾移植的患者在ScP诊断后存活超过数月。我们现在报告接受免疫抑制治疗（无论移植是否有功能）的患者生存期延长。在17例格拉斯哥患者的剖腹手术中发现了ScP，其中15例曾接触过酒精中的洗必泰。所有患者在诊断后均停止了CAPD。一年内，12例因复发性肠梗阻死亡；均未接受免疫抑制治疗。其余5例患者接受了免疫抑制治疗；4例在1至9年后仍存活，1例患有广泛血管疾病的患者在3年后因肠系膜缺血死亡。5例中有4例接受了肾移植。1例患者移植失败；当免疫抑制停止时，他出现了提示ScP复发的症状。重新开始免疫抑制治疗，3年后他仍然状况良好。第五例未接受移植的患者在ScP诊断后接受了免疫抑制治疗。18个月后她仍然状况良好。我们的经验表明，免疫抑制对ScP有益。
