术中透视在腹膜透析置管中的临床应用

Placement of peritoneal catheters with the assistance of X-ray fluoroscopy

目的:探讨腹膜透析置管时术中透视预防导管功能障碍中的作用。方法:168例终末期肾衰竭(ESRF)患者非随机分组:A组(常规手术组)和B组(常规手术+术中透视组)。所有患者随访时间1年。记录所有患者临床资料和置管相关并发症以及导管功能障碍的发生情况。结果:两组患者中9例出现出血性并发症(5.36%),其中出口处出血3例,切口血肿2例,血性引流液4例;膀胱穿孔和肠穿孔各1例(1.20%);透析液渗漏4例(2.38%),其中右侧胸腔积液2例,阴囊水肿2例;感染性并发症5例(2.98%),其中感染性腹膜炎1例,出口处感染4例,所有感染病例均得到控制。两组之间机械性并发症及感染性并发症发生率无显著性差异(P>0.05)。168例患者中无1例发生导管立即功能障碍,14例导管迟发功能障碍(8.33%),其中导管漂位9例(5.36%),其他原因所致5例(2.98%);11例患者导管功能障碍发生在术后30 d内,3例患者在术后30 d以后出现导管功能障碍(便秘所致)。A组患者导管迟发功能障碍12例(11.65%),其中导管漂位10例(83.33%),其他原因所致2例;B组患者导管迟发功能障碍2例,1例导管漂位,1例便秘,A组患者导管迟发功能障碍发生率明显高于B组,两组之间差异有统计学意义(P<0.05)。B组患者在置管过程中导管一次性到位率为91.3%。结论:导管功能障碍是腹膜透析通路的常见并发症,术中X线透视能及时发现置管时的导管位置异常,可有效预防迟发导管功能障碍,提高腹膜透析通路建立的成功率。

Objective： To evaluate the value of X-ray fluoroscopy in preventing catheter dysfunction during catheterization of peritoneal dialysis.Methods： A total of 168 patients with end-stage renal failure were nonrandomized into group A（the conventional catheterization group） and group B（the conventional catheterization ＋ bedside fluoroscopy group）.All patients were followed up for 1 year after the catheterization.Details of the patients’ general information,catheter-related complications and incidence of catheter dysfunction were analyzed.Results： Hemorrhagic complications occurred in 9 patients（5.36%）,including 2 incision hematomas,4 bloody fluid drainages,1 bladder perforation and 1 intestinal perforation（1.20%）.Dialysate leakages occurred in 4 patients（2.38%）： 2 right pleural effusion and 2 scrotal edemas.Infection-related complications（2.98%） in 5 patients were observed： 1 infectious peritonitis and 4 catheter exit infections.All peritoneal dialysis-related infections were cured after the treatment.There was no significant difference in the incidence of mechanical and infectious complications between the two groups（P 0.05）.No immediate catheter dysfunction was found in all patients,but late catheter dysfunction was observed in 14 patients（8.33%）,including 9 catheter migrations（5.36%）,5 of which were induced by other reasons（2.98%）.Catheter dysfunction in 11 out of the 14 patients occurred within 30 days post-catheterization,whereas 2 occurred over 30 days（caused by constipation）.In group A,12 patients developed delayed catheter dysfunction（11.65%）,10 of which（83.33%） were induced by catheter migration and the other 2 by other reasons.In group B,2（11.65%） delayed catheter dysfunctions were observed,including 1 catheter migration and 1 constipation.The incidence of catheter dysfunction in group A was significantly higher than that in group B（P ﹤0.05）.The success rate of catheterization in group B was 91.3%.Conclusion： Catheter dysfunction is a common complication in peritoneal dialysis.X-ray fluoroscopy during catheter insertion helps to monitor the location of the catheter,which can effectively prevent late catheter dysfunction and increase the success of catheterization in peritoneal dialysis.