腹透导管技术并发症课件

腹膜透析导管技术的相关问题腹膜透析导管种类导管置入技术目前存在的问题腹膜透析早期与晚期失败的原因•Siliconerubber(nearlyallcatheters)•Polyurethane(Cruzcatheter)Twomainmaterials(A)Flex-NeckTenckhoffcatheter,silicone(Medigroup,Oswego,IL,U.S.A.);(B)CruzTenckhoffcatheter,polyurethane;(C)StandardTenckhoffcatheter,silicone;(D)OneintraperitoneallimboftheT-flutedcatheter(AshAdvantage:AshAdvantageTechnology,Lafayette,IN,U.S.A.),silicone.FromS.Ash,withpermission.2.6mm,thestandardsizeoftheTenckhoffcatheter,swan-neckcatheter,Missouriswan-neckcatheter,andTWHcatheter3.1mm(Cruzcatheter)3.5mm[Flex-Neck(Medigroup,Oswego,IL,U.S.A.)andAshAdvantagecatheters]BMI>35腹膜透析导管种类导管置入技术目前存在的问题腹膜透析早期与晚期失败的原因外科手术置管法腹腔镜置管法X线透视下置管术导管置入技术PD置管过程中常见的并发症内脏损伤导管移位网膜包裹导管透析管出水不畅透析液渗漏疝腹膜炎及出口处感染麻醉意外导管位置不良移位堵塞或包裹所致的腹膜透析液引流不畅腹膜透析液渗漏疝机械并发症血脂代谢紊乱与腹膜透析置管大网膜包裹的关系中国血液净化2008年3月第7卷第3期

选择中南大学湘雅医院肾内科收集腹膜透析置管术后发生大网膜包裹病例15例，以同期未发生大网膜包裹病例30例为对照，对比二组发生血脂代谢紊乱的差异。同时，以是否存在血脂代谢紊乱分组，对比腹膜透析置管术后大网膜包裹的发生率。血脂代谢紊乱组20例，网膜包裹11例，网膜包裹率55%血脂代谢正常组25例，网膜包裹4例，网膜包裹率16%前者较后者显著升高，P＜0.05，差异有统计学意义。按照有无血脂代谢紊乱分组比较网膜包裹发生情况Othercomplicationsincludedpericatheterorsubcutaneousleak,hydrothorax,andmiscellaneous.200ofthesepatientsexperiencedatotalof217anatomiccomplications16patientshadmorethan1complication.Herniascomprised60.4%ofallcomplications:24.9%inguinal,18.9%umbilical,13.8%ventral,2.3%femoral,and0.5%intrathoracic.Othercomplicationsincludedpericatheterorsubcutaneousleak(25.3%),hydrothorax(6.0%),andmiscellaneous(8.3%).PeritonealdialysismodalitiesinuseatthetimeofcomplicationwereautomatedPD(52.3%),continuousambulatoryPD(38.6%),andnocturnalintermittentPD(9.1%).Theoverallincidenceofherniaswas7%.腹膜透析导管种类导管置入技术目前存在的问题腹膜透析早期与晚期失败的原因CONTRIBUTIONOFEARLYFAILURETOOUTCOMEONPERITONEALDIALYSISPeritDialInt2008;28:259–267ToanalyzetheimportanceofearlytreatmentfailureinPDandtocompareearlywithlatefailureswithrespecttoreasonsandpredictorsofriskforfailure.EarlyfailureofPDisfrequentandmakesanimportantcontributiontooverallPDoutcome.Inourpopulation,onethirdofallPDfailuresand40%ofalltechniquefailuresoccurredwithinthefirst6monthsfollowingcatheterimplantation.IdentificationofthemaincausesofearlyPDfailure(catheterimplantation,psychosocialproblems)isthefirststeptoimprovingoutcomebyinterventions(e.g.,improvementofcatheterimplantationtechnique,supporttopreventpsychosocialproblems).腹部和盆腔手术史对终末期肾病患者腹膜透析导管置管的影响有腹部和盆腔手术史(A)组25例无腹部和盆腔手术史(B)组86例其中A组具体手术如下:阑尾切除术7例、肾盂切开取石术7例、胆囊切除术6例、输卵管结扎术1例、剖宫产术2例、子宫切除术1例、胃大部切除术2例和脾脏切除术1例,其中2例曾接受2种手术治疗。丁小强等内科理论与实践2007年第2卷第6期

对先前有腹部和盆腔手术史的ESRD患者,如腹部手术范围较小、估计腹腔内粘连较轻者,一般仍可选择PD治疗。既往腹部和盆腔手术史对ESRD患者PD导管放置后短期和长期并发症的发生率没有显著影响。Tiong等分析了164例CAPD置管手术患者,结果发现43例先前有腹部手术史的患者中有18例(41.9%)置管术后出现短期(≤30d)并发症(如伤口出血或感染、导管移位、出口处出血或感染、早期腹膜炎、管周腹透液渗漏等),而121例无腹部手术史的患者中只有32例(26.4%)置管术后出现短期(>30d)并发症。作者认为先前腹部手术史是CAPD短期并发症的高危因素。TiongHY,etal.SingaporeMed,2006,47(8):707-711.回顾性分析上海长征医院1999年～2008年由腹膜透析转血液透析治疗的39例患者①透析不