持续非卧床性腹膜透析并发胸腹瘘临床研究

Clinical study continuous ambulatory peritoneal dialysis complicated by abdominal fistula

目的：探讨持续非卧床性腹膜透析（CAPD）患者并发胸腹瘘（AF）的临床表现、诊断方法及治疗与转归。方法观察广东省佛山市南海区人民医院肾内科2009年1月～2012年2月收治的3例CAPD并发胸腹瘘患者，对其临床表现、诊断方法及治疗与转归进行分析与总结。结果3例患者均出现气促、胸闷、不能平卧，伴超滤量明显减少，影像学提示中-大量右侧胸腔积液；应用胸水生化成分分析鉴定胸水性质，同时以标记放射性核素99Tcm-乙三胺五乙酸（DPTA）注入透析液后，在胸膜腔中探测到99Tcm确诊；经抽取胸水、暂停CAPD、改行间隙性腹膜透析等治疗方法效果欠佳，3例患者最终都转为血液透析治疗。结论从临床表现可早期发现胸腹瘘，用核素扫描结合胸水生化成分分析诊断胸腹瘘敏感性高，不良反应少。出现胸腹瘘后患者较难再维持腹膜透析治疗。

Objective To investigate the clinical manifestations, diagnosis methods and treatment and prognosis of patients with continuous ambulatory peritoneal dialysis（CAPD） complicated by abdominal fistula（AF）. Methods Three patients with CAPD complicated by AF who were treated in the nephrology department of Foshan Nanhai People＇s Hospital from January 2009 to February 2012 were observed, and their clinical manifestations, diagnosis methods and treatment and prognosis were analyzed and summarized. Results All 3 patients had shortness of breath, chest tightness, supine position enabling and significantly reduced amount of ultrafiltration; Imaging suggested medium to large quantity of right pleural effusion. The biochemical component analysis method was used to identify the quality of pleural effusion, and after the radionuclide 99Tcm-diethylenetriamine penta acetic acid（DPTA） was injected in dialyzate, detection of 99Tcm in pleural cavity confirmed the diagnosis. After the failure of pleural effusion extraction, CAPD suspension, intermittent peritoneal dialysis and other treatment methods, all 3 patients changed to blood dialysis treatment. Conclusion Abdominal fistula can be detected early based on clinical manifestations. The combined application of radioisotope scanning and biochemical component analysis of pleural effusion shows high sensitivity and few adverse reactions in the diagnosis of abdominal fistula. Maintenance of Peritoneal dialysis is difficult after the appearance of abdominal fistula.