不同类型腹膜透析导管的临床应用

The catheter-related complications in peritoneal dialysis using different catheters: experience from 820 peritoneal dialysis cases

目的 回顾性总结820例不同类型腹膜透析导管的并发症发生情况,掌握不同类型导管的优缺点,探讨如何合理选择导管类型.方法 选取2002年1月～2011年8月在本中心置管行腹膜透析的终末期肾衰竭患者820例,分别选用Tenckhoff卷曲管（T型曲管）、鹅颈型卷曲管（S-N卷曲管）、鹅颈型直管（S-N直管）.采用开放式外科手术置管法,由同一手术者操作,均以旁正中2cm为手术切口.T型曲管S直管以耻骨联合上12cm为置管位置,S曲管根据不同置管阶段分别以耻骨联合上13cm、15cm、17cm为置管位置.随访时间均大于3个月,观察各种导管相关并发症的发生情况.结果 共纳入腹膜透析置管术患者820例,采用Tenckhoff卷曲管231例、鹅颈型卷曲管126例、鹅颈型直管（S-N直管）463例.其中男性490例,女性330例,平均年龄（42.3±14.7）岁,慢性肾小球肾炎622例,狼疮性肾炎52例,糖尿病肾病65例,慢性间质性肾炎22例,高血压肾损害19例,多囊肾10例,其他30例.导管移位情况：T型曲管组、S-N曲管组、S-N直管组分别为12例（5.2％）、19例（15.1％）和9例（1.9％）,x2=36.900,P=0.001;其中S-N曲管组以耻骨联合上13cm、15cm、17cm为置管位置时发生导管移位的例数分别为5例（3.9％）、6例（4.7％）和8例（6.3％）,x2=3.121,P=0.268.3组导管阻塞发生率分别为7例（3.0％）、6例（4.8％）和9例（1.9％）,x2=3.161,P=0.206.重新置管的分别为6例（31.5％）、10例（40.0％）和7例（38.9％）,x2=12.255,P=0.002.导管自行复位的分别为1例（8.3％）、4例（21.0％）和6例（66.7％）,x2=10.364,P=0.006.3组隧道感染分别为0例、1例（0.21％）和0例,x2=0.772,P=0.680;隧道口感染分别为2例（0.86％）、2例（0.21％）和2例（0.79％）,x2=3.857,P=0.145. 结论 鹅颈直管组的导管移位发生率最低.而鹅颈卷曲管组的导管移位率发生率高,且不易自行复位,重新置管率高.3种导管的隧道及隧道口感染率类似.

Objective To seek a suitable type of peritoneal dialysis （PD） catheter by comparing catheter- related complications in patients used Tenckhoff coiled catheter, swan-neck coiled catheter or swan-neck straight catheter. Methods A total of 820 end-stage renal disease patients with catheterization for mainte- nance PD in this center from Jan. 2002 to Aug. 201l were enrolled in this study. The catheter used included Tenckhoff coiled catheter （n=231）, swan-neck coiled catheter （n= 126） and swan-neck pipe （n=463）. Open sur- gery was used for the placement of the catheters. The incisions located at 2.5cm aside from the center line, 12cm above pubic symphysis for Tenckhoff coiled and swan-neck straight catheters, and 13cm, 15cm or 17cm above pubic symphysis for swan-neck coiled catheter according to the catheterization stage. They were fol- lowed up for more than three months, and catheter-related complications were observed. Results In the 820 patients, 490 cases were males and 330 cases were females with the average age of 42.3±14.7 years （13-92 years of age）. The primary diseases for PD included chronic glomerulonephritis （n=622）, lupus nephritis （n= 52）, diabetic nephropathy （n=65）, chronic interstitial nephritis （n=22）, hypertensive renal damage （n=19）, polycystic kidney disease （n=10）, and other （n=30）. Catheter dislocation was found in 12 cases （5.2%）, 19 cases （15.1%） and 9 cases （1.9%） in Tenckhoff coiled, swan-neck coiled, and swan-neck straight catheter groups, respectively （Z2=36.900, P=-0.001）, and was found in 5 cases, 6 cases and 8 cases in swan-neck coiled catheter group placed the catheters 13cm, 15cm, and 17cm above pubic symphysis respectively （X^2=3.121, P=-0.268）. In Tenckhoff coiled, swan-neck coiled, and swan-neck straight catheter groups, catheter obstruction was found in 7 cases （3.0%）, 6 cases （4.8%）, and 9 cases （1.9%） respectively （X^2=3.161, P=0.206）, re-catheterization was performed in 6 cases, 10 cases, and 7 cases respectively （X^2=12.255, P=-0.002）, reset of the dislocated catheters occurred in one case, 6 cases, and 4 cases respectively （X^2=10.364, P=-0.006）, and tunnel orifice infection oc- curred in 2 cases in every groups （X^2=3.857, P=-0.145）. Conclusion The rate of catheter dislocation was low-est in swan-neck straight catheter group, and was highest in swan-neck coiled catheter group. In swan-neck coiled catheter group, the catheter dislocation was relatively difficult to be reset with higher rate of re-catheterization.