腹膜造影ctpptppt课件

Complicationsofperitonealdialysis evaluationwithCTperitoneography 北大医院腹组早读片2011 03 09 NTRODUCTION Continuousambulatoryperitonealdialysis 持续性非卧床腹膜透析CAPD isusedtotreatendstagerenalfailureinanincreasingnumberofpatients CAPDhasanadvantageoverhemodialysisinthatitallowspatientsgreaterfreedomtoperformdailyactivities italsoprovidesotherclinicalbenefits However thelong termeffectivenessofCAPDislimitedbycomplications whichhavevariouscauses INDICATIONSANDTECHNIQUE 适应症 复发性腹膜炎 透析液交换困难 腹壁或生殖器软组织水肿 腹壁局限性膨出 超滤减少方法 在CT腹膜造影前 腹腔的透析液要完全引流 1ml kg非离子型造影剂 30ml kg透析液混匀 缓慢输入腹腔 要求严格无菌操作 患者行走 翻身等活动30分钟后CT扫描 检查完毕将含有造影剂的腹透液置换出来 NORMALFINDINGS Limiteddispersionduetoadhesions ABNORMALFINDINGS Peritonitis BacterialperitonitisisthemostcommoncomplicationofCAPD PatientsundergoingCAPDaremoresusceptibletotuberculousperitonitisthanthosewithnormalrenalfunctionorthoseundergoinghemodialysis partlybecauseoftheirdecreasedcellularimmunity Infectedfluidcollections Tuberculousperitonitis Catheter relatedComplications CatheterMalposition Thedistalcathetertipshouldbeinsertedinadependentpositionintotherectovesicalpouch inmalepatients ortherectouterinepouch infemalepatients CatheterKinking CatheterEntrapment CatheterMalposition CatheterKinking Catheterentrapment DialysateLeakageandHernias Suddenincreasesinpressuremayleadtothedevelopmentofherniasandleaks Dialysateleaksmayresultinpoordrainageofdialysateandsignificantfluidretention ThemostcommonsitesofherniasthatoccurascomplicationsofCAPDareattheumbilicus neartheperitonealincisionforcatheterinsertion andintheinguinalcanal SclerosingEncapsulatingPeritonitis HepaticSubcapsularSteatosis References 1 Wang Q Ni ZH Zhu ML etal DiagnosticvalueofCTperitoneographyfornon infectiouscomplicationsofperitonealdialysis J ZhongXiYiJieHeXueBao 2008 6 5 478 81 2 Prokesch RW Schima W Schober E etal Complicationsofcontinuousambulatoryperitonealdialysis findingsonMRperitoneography J AJRAmJRoentgenol 2000 174 4 987 91 3 Cochran ST Do HM Ronaghi A etal Complicationsofperitonealdialysis evaluationwithCTperitoneography J Radiographics 1997