腹膜透析患者合并腹壁疝或阴囊积液的单中心回顾性队列研究

Peritoneal dialysis patients with abdominal hernia or hydrocele:a single-center retrospective cohort study

目的分析腹膜透析(腹透)患者合并腹壁疝或阴囊积液的发生率、影响因素和临床预后。方法本研究为单中心回顾性队列研究。研究对象来自2003年1月1日至2019年7月31日期间北京大学第一医院的新入腹透患者。收集患者基线一般人口学资料和血生化检查结果,并评估残余肾功能。记录随访期间患者腹壁疝或阴囊积液的发生情况,按照患者是否发生腹壁疝和/或阴囊积液分为腹壁疝和/或阴囊积液组和对照组,比较两组间临床表现的差异。Cox回归模型法分析腹透患者合并腹壁疝或阴囊积液的影响因素。结果共1 291例腹透患者入选本研究,年龄(56.2±15.1)岁,男性占50.9%,合并糖尿病者占39.6%,有腹腔手术史者占16.3%。中位随访时间30.1(13.2, 61.7)个月,期间有54例(4.2%)腹透患者发生腹壁疝或阴囊积液,发生率0.012次/患者年,其中腹壁疝46例,阴囊积液8例,分别占比85.2%和14.8%。与对照组比较,腹壁疝或阴囊积液组男性占比、Karnofsky功能状态评分和握力水平较高(均P<0.05)。多因素Cox回归模型分析结果显示,男性是腹透患者发生腹壁疝或阴囊积液的独立影响因素(HR=8.368,95%CI 2.413~29.016,P=0.001)。合并腹壁疝或阴囊积液的患者中41例(75.9%)经疝修补术或联合精索鞘膜结扎术后继续接受腹透治疗,中位随访时间25.3(10.4, 39.7)个月,2例复发(4.9%)。8例(14.8%)患者放弃手术转血液透析治疗,5例(9.3%)患者接受保守治疗维持腹透。结论本中心腹透患者合并腹壁疝或阴囊积液发生率为4.2%,低于既往报道。75.9%的患者经手术修补后预后良好。

Objective To retrospectively analyze the incidence,influencing factors and clinical outcomes of abdominal hernia or hydrocele in peritoneal dialysis(PD)patients.Methods Based on the retrospective cohort of PD in Peking University First Hospital between 1 January 2003 and 31 July 2019,baseline data including demographic characteristics as well as blood biochemical data and residual renal functions were collected,with the occurrence of abdominal hernia or hydrocele recorded during follow-up.Patients were divided into abdominal hernia and/or hydrocele group and control group according to whether abdominal hernia and/or hydrocele occurred during follow-up.The differences in clinical manifestations between the two groups were compared.Cox regression model was used to analyze the influencing factors of abdominal hernia or hydrocele in PD patients.Results A total of 1291 PD patients were enrolled,with age of(56.2±15.1)years.Of them,50.9%were male,39.6%had diabetes mellitus and 16.3%had the history of operation in abdomen.During the follow-up of 30.1(13.2,61.7)months,a total of 54 patients(4.2%)developed abdominal hernia or hydrocele(incidence rate 0.012 per patient year),including 46(85.2%)abdominal hernias and 8(14.8%)hydroceles.Compared to the control group,the proportion of males,Karnofsky performance status score and hand grip strength were significantly higher in the abdominal hernia and/or hydrocele group(P<0.05,respectively).Male gender was the independent influencing factor for hernia or hydrocele formation during PD(HR=8.368,95%CI 2.413-29.016,P=0.001).Among the patients with abdominal hernia or hydrocele,there were 41(75.9%)patients continued the PD after receiving hernia repair or repair of the testicular sheath membrane operations,2(4.9%)patients recurred in the follow-up of 25.3(10.4,39.7)months,8(14.8%)patients gave up surgery and transferred to hemodialysis,and 5(9.3%)patients received conservative treatment and continued the PD.Conclusion The incidence rate of abdominal hernia or hydrocele in PD patients of our center is 4.2%,which is lower than that in previous studies,and 75.9%patients receiving repair operations have favorable prognosis.