透视引导下腹膜透析导管介入导丝复位术的临床应用

Clinical application of fluoroscopy-guided interventional guide-wire technique in restoring the correct position of displaced peritoneal dialysis catheter

目的评估透视引导下腹膜透析导管介入导丝复位术的临床应用。方法收集2018年8月—2020年1月肾脏内科行维持性腹膜透析治疗的终末期肾病,且出现腹膜透析导管移位及腹透液引流障碍的患者,对照组为仅行物理复位,观察组为物理复位失败,行介入导丝复位术,比较两组复位成功率和安全性。结果共入选48例符合入组标准的患者,24例为对照组,24例为观察组,两组年龄、性别、基础疾病、导管移位时间比较,差异无统计学意义。对照组(5/24)与观察组(18/24)复位成功率比较,差异有统计学意义(P<0.05)。观察组手术时间为12 min(6~35 min)。观察组术中9例患者出现腹部不适感,5例可忍受,4例出现腹部疼痛,停止操作后疼痛缓解。术后两组均未发生腹腔出血、脏器损伤及腹膜炎。结论透视引导下腹膜透析导管介入导丝复位术是腹膜透析患者导管移位的一种有效、安全的治疗方法。

Objective To evaluate the clinical application of fluoroscopy-guided interventional guidewire technique in restoring the correct position of displaced peritoneal dialysis catheter. Methods The clinical data of 48 patients with end-stage nephropathy, who were admitted to the Department of Nephrology of the Affiliated Shengjing Hospital of China Medical University to receive maintenance of peritoneal dialysis and who developed peritoneal dialysis catheter displacement during the period from August 2018 to January 2020, were collected. Physical restoration of displaced catheter was adopted in the patients of the control group, and fluoroscopy-guided interventional guide-wire technique was used in the patients of the study group after physical restoration technique failed. The success rate of catheter position restoration and safety were compared between the two groups. Results A total of 48 patients who met the inclusion criteria were enrolled in this study. The control group had 24 patients and the study group had 24 patients. No statistically significant differences in age, sex, underlying disease and catheter displacement time existed between the two groups. The success rate of catheter position restoration in the control group and the study group was 20.8%(5/24) and 75.0%(18/24) respectively, the difference between the two groups was statistically significant(P<0.05). The time spent for operation in the study group was 12 min(within 6-35 min). In the study group 9 patients developed abdominal discomfort, which was tolerable in 5 of them. Four patients developed abdominal pain,which was relieved after stopping the operative manipulation. After treatment, no abdominal hemorrhage,visceral organ damage or peritonitis occurred. Conclusion For displaced peritoneal dialysis catheter,fluoroscopy-guided interventional guide-wire technique is an effective and safe treatment.