腹膜透析患者接受導管部分切除及植入之預後討論

趙梓辰、游智欽

台北慈濟醫院  泌尿科

Clinical Outcomes of Partial Resection and Replantation of Peritoneal Dialysis Catheter in End Stage Renal Disease Patients under Continuous Ambulatory Peritoneal Dialysis

Tze-Chen Chao, Chih-Chin Yu

Division of Urology, Taipei Tzuchi General Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan

Purpose: Persistent exit site infection and tunnel infection (ESTI) of peritoneal dialysis catheter (PDC) remain common complications in end stage renal disease (ESRD) patients receiving peritoneal dialysis. Partial resection of the PDC and replantation with a new tunnel is a feasible treatment to avoid removal of whole catheter and therefore to prolong the catheter life. However, few literatures have elaborated the method of the surgery and the further outcomes. Our study aims to describe the operation method and to evaluate outcomes of our patients who received partial resection and replantation of the PDC.

Materials and Methods: We included patients diagnosed with medical failure of exit site infection, tunnel infection, broken catheter, or external cuff migration in to the retrospective study. All patients received partial resection and replantation of PDC. Among patients diagnosed with ESTI, at least 2-3 weeks of antibiotics were given. Patient demographic and clinical data were collected. Recurrent infection rate and survival of the PDC were recorded.

Surgical technique: Under laryngeal mask general anesthesia, a transverse incision along the catheter pathway at the medial side of the external cuff was made. Wound was deepened to find the PDC. The PDC was transacted and reconnected with one endoluminal adaptor. The new tunnel was created with a J-shape stylet. Wound was then closed with 3-o nylon.

Results: From June 2016 to May 2020, seventeen patients were referred to urology department for partial retention and replantation because of ESTI, tunnel infection, or external cuff migration. Male and female ratio was 7/10 with a mean age of 56 years old (40-85). Totally 19 surgeries were performed in this 17 patients, of whom 13(68%) were because of exit site infection, 3(16%) broken catheter, 2(10%) external cuff migration, and 1(5%) tunnel infection. All the patients resume PD immediately after the surgery. Only single dose of preoperative antibiotic was prescribed. After follow-up time of 4-36 months, the mean catheter survival was 14.6 months (3-27). Among 14 ESTI cases, 7 had no recurrent infection, 2 had peritonitis and later removal of catheter, 1 had another episode of ESTI and treated with partial resection, 2 had recurrent infection and successfully treated by antibiotics, 1 had lost to follow-up and 1 had expired.

Conclusions: Our results showed similar to previous case series with a easy surgical technique. From the case series, only one dose of preoperative antibiotics is sufficient after treatment of active infection. Partial resection and replantation of the PDC is effective to prolong the catheter life in our patients without other major complications.