Lewis M, Webb N, Smith T, Roberts D
Department of Paediatric Nephrology, Royal Manchester Children's Hospital, United Kingdom.
Adv Perit Dial. 1995;11:293-5.
A routine omentectomy is recommended in children commencing chronic peritoneal dialysis, but is not routine practice in adults. We reviewed the outcome of 66 catheters (57 straight and 9 spiral) inserted into 38 patients (median age 7.8 years, 12 patients under 2 years) over a period of 4.8 years. The aim of the study was to determine whether an omentectomy affects the incidence of catheter blockage or peritonitis. Mean catheter life was 6.8 months (range 0.2-28 months). Fifteen are still in situ, and 14 were removed electively (transplantation). Blockage occurred in 1/22 catheters inserted after an omentectomy, compared with 10/44 inserted without an omentectomy (absolute risk reduction with omentectomy = 0.18). Blockage was more frequent with spiral catheters (4/9 vs 7/57; p < 0.05). Thirty-seven catheters were associated with one or more episodes of peritonitis. Peritonitis was not significantly more frequent after omentectomy. We conclude that a routine omentectomy is not routinely indicated in children commencing chronic peritoneal dialysis. Eleven omentectomies are required to prevent two omental blockages (1/0.18), and secondary omentectomy after blockage is a straightforward procedure. Spiral catheters conferred no benefit in this study. Omentectomy does not influence the incidence of peritonitis.
对于开始进行慢性腹膜透析的儿童，建议常规行网膜切除术，但在成人中并非常规操作。我们回顾了在4.8年期间为38例患者（中位年龄7.8岁，12例2岁以下）插入的66根导管（57根直管和9根螺旋管）的结果。本研究的目的是确定网膜切除术是否会影响导管堵塞或腹膜炎的发生率。导管平均使用时间为6.8个月（范围0.2 - 28个月）。15根导管仍在使用，14根被择期拔除（用于移植）。网膜切除术后插入的22根导管中有1根发生堵塞，而未行网膜切除术插入的44根导管中有10根发生堵塞（网膜切除术使绝对风险降低 = 0.18）。螺旋导管堵塞更频繁（4/9 vs 7/57；p < 0.05）。37根导管与一次或多次腹膜炎发作相关。网膜切除术后腹膜炎的发生频率没有显著增加。我们得出结论，对于开始进行慢性腹膜透析的儿童，不常规建议行网膜切除术。需要进行11次网膜切除术以预防2次网膜堵塞（1/0.18），堵塞后行二期网膜切除术是一个简单的操作。在本研究中，螺旋导管没有益处。网膜切除术不影响腹膜炎的发生率。
