腹膜透析导管高位隧道出口对漂管发生率的影响

Effect of tunnel outlet of peritoneal dialysis catheter on the incidence of drift catheter

目的探讨腹膜透析(PD)导管隧道出口位置对PD导管功能障碍及感染的影响。方法对2011年11月至2021年2月于大连医科大学附属第二医院肾内科外科手术置管腹膜透析患者352例进行回顾性分析。所有患者采用双卡夫Tenckhoff直管,局部麻醉外科手术法置管。按照腹透导管出口位置分为观察组(高位出口)182例和对照组(低位出口)170例。比较分析两组间漂管发生率及感染率差异。结果观察组漂管8例,漂管发生率4.4%,手法复位成功率100%;对照组漂管19例,漂管发生率11.2%,手法复位成功13例,成功率68%,再次手术6例,成功率100%。两组漂管发生率比较差异有统计学意义(P<0.05)。腹透相关感染情况两组间无明显差异。结论采取高位导管隧道出口方式,可减少漂管的发生,同时也不增加感染等并发症。调整隧道出口位置及方向对于维持腹透管的良好功能具有较好的作用。

Objective To investigate the effect of peritoneal dialysis(PD) catheter outlet location on PD catheter dysfunction and infection. Methods Retrospective analysis was performed on patients undergoing catheterized peritoneal dialysis in the Department of Nephrology of the Second Affiliated Hospital of Dalian Medical University from November 2011 to February 2021. The patients were divided into observation group(upper outlet, 182 cases) and control group(lower outlet, 170 cases) according to the outlet position of the peritoneal diathermal catheter. Double Kraft Tenckhoff straight tube was used to place the tube under local anesthesia. The differences of drift tube incidence and infection rate between the two groups were compared and analyzed. Results There were 8 cases of drift tube in the observation group. The incidence of drift tube was 4.4% and the success rate of manual reduction was 100%. In the control group, there were 19 cases of tube drift, the incidence of tube drift was 11.2%. Among them, 13 cases had successful manual reduction, the success rate was 68%;6 cases had reoperation, the success rate was 100%. There was no difference in peritoneal dialysis associated infection between the two groups. Conclusion The incidence of drift tube in patients with high tunnel outlet is significantly decreased, and no increased complications such as infection are observed. Adjusting the position and direction of tunnel outlet is feasible to maintain the good function of peritoneal tube.