迟发性腹膜透析液渗漏的CT诊断及分析

CT diagnosis of delayed dialysate leakage in continuous ambulatory peritoneal dialysis

目的总结持续性非卧床腹膜透析(CAPD)患者发生迟发性腹膜透析液渗漏的CT表现。方法回顾我院有CT平扫资料的286例CAPD病例,其中25例发生迟发性透析液渗漏(男9例,女16例,年龄27~73岁);发生渗漏时患者已持续腹膜透析1~10年。所有患者均行CT平扫,其中5例为腹腔注入稀释对比剂后扫描(腹膜腔造影)。复习其临床及CT资料,对患者透析液渗漏的部位、路径、诱发因素进行分析与总结。结果本组迟发性透析液渗漏发生率为8.7%(25/286);女性较男性多见(16∶9);发病年龄多在40岁以上(84%,21/25);渗漏可发生在CAPD各个时期,且每年新发渗漏的病例数相对恒定。单发局限性腹膜透析液渗漏15例,CT平扫表现为囊袋状、条片状影向腹壁外突出,囊内为透析液。渗漏发生部位为:脐部6例,腹股沟-会阴部4例(其中2例男性出现阴囊积液),腹壁4例(侧下腹壁3例,前下腹壁1例),闭孔区1例;2例合并感染者边界不清,其余13例边界清晰。多发腹膜透析液渗漏10例,CT平扫表现为透析液向腹壁间或腹壁外广泛渗出,腹壁、会阴部软组织广泛肿胀。结论迟发性腹膜透析液渗漏呈散发性发病,易发生在腹壁薄弱处,40岁以上女性患者相对多见。CT平扫可显示腹膜透析液渗漏的部位和特点。

Objective To investigate the CT findings of delayed dialysate leakage in patients with continuous ambulatory peritoneal dialysis(CAPD).Methods The CT of 286 CAPD patients was retrospectively analyzed.25 patients(9 men and 16 women,age range:27-73 years)had delayed dialysate leakage after 1-10 years of CAPD.Unenhanced CT was performed on all patients and 5 patients received intraperitoneal injection of diluted contrast agent.The location,route and inducing factors of dialysate leakage were evaluated.Results The incidence of delayed dialysate leakage was 8.7%(25/286)with 16 female:9 male ratio,84%(21/25)over 40 years of age.Leakage could occur during each CAPD period with the relatively constant number of new cases every year.Single localized peritoneal dialysis fluid leakage(15)was shown on CT as protruding fluid sacs at the umbilical cord(6),inguinal-perineal region(4 including scrotal effusion in 2 men),inferior lateral abdominal wall(3),anterior inferior abdominal wall(1),and obturator foramen(1).The boundary of dialysate fluid sacs was unclear in 2 patients with co-infection and clear in the remaining 13 patients.Multiple peritoneal dialytic fluid leakage sites(10)were shown on CT as fluid sacs protruding from the abdominal wall and/or extensive abdominal wall and perineum soft tissue swelling.Conclusion Delayed dialysate leakage is sporadic and prone to occur in the weak areas of abdominal wall,ore common in women over 40 years of age.CT showed dialysis fluid protruding to the abdominal wall with extensive abdominal wall and perineum soft tissues swelling.