Diaz-Buxo J A, Turner M W, Nelms M
Metrolina Nephrology Associates, Metrolina Kidney Center, Charlotte, North Carolina, USA.
Clin Nephrol. 1997 Jun;47(6):384-8.
Wire manipulation under fluoroscopic control can correct malposition of peritoneal catheters in a fast and safe manner. This study was performed to evaluate the success rate of wire manipulation and identify factors that may predict outcome.
Data were prospectively collected between January 1, 1986 and June 30, 1996 among all patients with peritoneal catheter malfunction requiring manipulation at a single center. Manipulations were performed using a flexible guide wire under aseptic fluoroscopic control. All patients had flat plates of the abdomen pre and post manipulation and received antibiotics after the procedure. The direction of the subcutaneous tunnel at the point of entry into the peritoneal cavity was calculated from the X-rays by measuring the angle formed by the horizontal and the distal subcutaneous tunnel. Success was defined as adequate peritoneal catheter function at three months. The success rate was correlated with type of catheter, patient weight and the subcutaneous tunnel orientation.
1250 Tenckhoff double-cuff peritoneal catheters were inserted and 69 (5.5%) were manipulated (59 straight and 10 curled). The median for time elapsed between peritoneal catheter insertion and wire manipulation was 18 days (range 1 day-5 years). The overall success rate was 60.9% (61% for straight and 60% for curled peritoneal catheters). The mean patient weight for successes was 71.4 +/- 12.4 and 84.0 +/- 17.2 kg for failures (p < 0.005). Subcutaneous tunnel orientation between 30 and 120 degrees was associated with the highest success and those beyond 120 degrees with the highest failure rate. No complications were observed.
Wire manipulation under fluoroscopic control of Tenckhoff peritoneal catheter in the treatment of malfunction is a safe and highly effective procedure. Obesity and cephalad orientation of the subcutaneous tunnel were associated with less favorable outcome.
在荧光透视控制下进行导丝操作能够快速、安全地纠正腹膜导管的位置异常。本研究旨在评估导丝操作的成功率，并确定可能预测结果的因素。
前瞻性收集了1986年1月1日至1996年6月30日期间在单一中心所有需要进行操作的腹膜导管功能障碍患者的数据。在无菌荧光透视控制下使用柔性导丝进行操作。所有患者在操作前后均拍摄腹部平片，并在术后接受抗生素治疗。通过测量水平方向与皮下隧道远端形成的角度，从X线片计算腹膜腔入口处皮下隧道的方向。成功定义为三个月时腹膜导管功能良好。成功率与导管类型、患者体重和皮下隧道方向相关。
共插入1250根Tenckhoff双套囊腹膜导管，其中69根（5.5%）进行了操作（59根笔直，10根卷曲）。腹膜导管插入与导丝操作之间的中位时间为18天（范围1天至5年）。总体成功率为60.9%（笔直腹膜导管为61%，卷曲腹膜导管为60%）。成功患者的平均体重为71.4±12.4 kg，失败患者为84.0±17.2 kg（p<0.005）。皮下隧道方向在30度至120度之间的成功率最高，超过120度的失败率最高。未观察到并发症。
在荧光透视控制下对Tenckhoff腹膜导管进行导丝操作以治疗功能障碍是一种安全且高效的方法。肥胖和皮下隧道头侧方向与较差的结果相关。
