持续性非卧床腹膜透析渗漏并发症的临床分析

Clinical analysis of continuous ambulatory peritoneal dialysis complicated by abdominal fistula

目的:探讨持续性非卧床腹膜透析(Continuous Ambulatory Peritoneal Dialysis,CAPD)患者并发腹膜渗漏的临床表现、诊断、治疗及转归。方法:206例行CAPD尿毒症患者中17例患者并发腹膜渗漏,对各自的临床表现,诊断方法、治疗及转归进行分析与总结。结果:3例胸腹瘘(abdominal fistula,AF)患者均改为血液透析治疗;1例后腹膜渗漏患者终止CAPD改为长期血液透析(long-term hemodialysis,HD);2例睾丸鞘膜积液患者改间歇性腹膜透析(intermittent peritoneal dialysis,IPD)后,症状减轻,仍继续腹膜透析治疗,但血肌酐较高,透析不充分;11例管周渗漏患者均治愈,继续CAPD治疗。结论:从临床表现均可早期发现腹膜渗漏,胸腹瘘及后腹膜渗漏用核素扫描结合漏出液生化分析诊断敏感性高,不良反应少,出现胸腹瘘及严重后腹膜渗漏很难继续CAPD治疗,管周渗漏停止腹膜透析或改行IPD治疗2周后均可继续CAPD治疗。

Objective： To investigate the clinical manifestations,diagnosis,treatment and prognosis of patients with continuous ambulatory peritoneal dialysis（ CAPD） complicated by abdominal fistula. Methods： In 206 cases of CAPD,17 cases were complicated by abdominal fistula,with the clinical manifestations,diagnosis,treatment and prognosis analyzed and summarized. Results： 3 patients with abdominal fistula were treated with hemodialysis instead; 1 patient with retroperitoneal leakage was treated with long- term hemodialysis（ HD） instead of CAPD; 2 patients with hydrocele testis received intermittent peritoneal dialysis（ IPD） so that the symptoms were relieved and the peritoneal dialysis was continued,but the serum creatinine was higher,and the dialysis was not sufficient; 11 patients with pipe leakage were cured and were treated with CAPD again. Conclusion： Abdominal fistula can be found from the early clinical manifestations; AF and retroperitoneal leakage has high sensitivity by nuclide scanning combined with transudate biochemical analysis and has little side reaction. It is difficult to continue CAPD in the occurrence of the AF and the severe retroperitoneal leakage. Patients with pipe leakage can be treated continuously with CAPD for 2 weeks after the discontinuation of peritoneal dialysis or be treated with IPD instead.