Suh H, Wadhwa N K, Cabralda T, Sorrento J
Division of Nephrology and Hypertension, State University of New York at Stony Brook, USA.
Adv Perit Dial. 1996;12:192-5.
Our objective was to study endogenous peritonitis and related catheter outcome in peritoneal dialysis (PD) patients. The study was designed to investigate endogenous peritonitis and related catheter loss in all end-stage renal disease (ESRD) patients who started peritoneal dialysis from January, 1989 to September, 1995. In a tertiary-referral university hospital, 192 ESRD patients (117 male, 75 female) who entered the home program from 1/89 to 9/95 were studied. Sixteen episodes of endogenous peritonitis occurred in 15 PD patients (7 male, 8 female) with a mean age of 63 years (range 33-81 years). Five patients were diabetic. Two hundred and seventeen episodes of peritonitis in 192 patients occurred over 4149 patient-months, resulting in one episode/19.1 patient-months. Sixteen episodes of endogenous peritonitis were encountered in 15 patients, accounting for 7% of all episodes of peritonitis. The mean duration of PD before contracting endogenous peritonitis was 24.2 months (range 7-52 months). Eleven episodes were related to diverticular leak/perforation, three to sigmoidoscopy/colonoscopy/PEG procedures, one to unknown etiology, and one to cholecystitis. During 11 episodes, severe constipation preceded. All the patients were initially treated conservatively with antibiotics. Five episodes (31%) responded to antibiotic therapy alongside antifungal prophylaxis and continued PD. One episode (6%) required cholecystectomy without catheter removal and resumed PD. Six episodes (38%) required catheter removal due to subsequent fungal peritonitis in a mean of 11 days (range 3-24 days): 4 patients transferred to hemodialysis and 2 patients resumed PD. Three patients underwent catheter removal along with colectomy and colostomy: 2 patients transferred to hemodialysis and 1 patient died in ten days. One patient refused surgery and died in 16 days. Endogenous peritonitis resulted in a high incidence of catheter loss and dropout from PD. Peritonitis due to bowel leak without frank bowel perforation can be managed with antibiotic therapy and antifungal prophylaxis. Aggressive management of constipation may decrease endogenous peritonitis.
我们的目的是研究腹膜透析（PD）患者的内源性腹膜炎及相关导管结局。该研究旨在调查1989年1月至1995年9月开始腹膜透析的所有终末期肾病（ESRD）患者的内源性腹膜炎及相关导管丢失情况。在一家三级转诊大学医院，对1989年1月至1995年9月进入家庭治疗项目的192例ESRD患者（117例男性，75例女性）进行了研究。15例PD患者（7例男性，8例女性）发生了16次内源性腹膜炎，平均年龄63岁（范围33 - 81岁）。5例患者患有糖尿病。192例患者在4149个患者月中发生了217次腹膜炎，即每19.1个患者月发生1次。15例患者发生了16次内源性腹膜炎，占所有腹膜炎发作的7%。发生内源性腹膜炎前的平均腹膜透析时间为24.2个月（范围7 - 52个月）。11次发作与憩室渗漏/穿孔有关，3次与乙状结肠镜检查/结肠镜检查/经皮内镜下胃造口术有关，1次病因不明，1次与胆囊炎有关。在11次发作期间，之前均有严重便秘。所有患者最初均采用抗生素保守治疗。5次发作（31%）对抗生素治疗及抗真菌预防有效，继续进行腹膜透析。1次发作（6%）需要进行胆囊切除术且不拔除导管，之后恢复腹膜透析。6次发作（38%）由于随后发生真菌性腹膜炎，平均11天（范围3 - 24天）后需要拔除导管：4例患者转为血液透析，2例患者恢复腹膜透析。3例患者拔除导管并进行结肠切除术和结肠造口术：2例患者转为血液透析，1例患者在10天后死亡。1例患者拒绝手术，16天后死亡。内源性腹膜炎导致导管丢失和退出腹膜透析的发生率较高。因肠道渗漏而非明显肠道穿孔引起的腹膜炎可通过抗生素治疗和抗真菌预防进行处理。积极处理便秘可能会减少内源性腹膜炎的发生。
