在移除腹膜透析導管時，以腎臟鏡輔助下置入腹腔引流管，可減少難治性腹膜透析相關之腹膜炎的腹內併發症風險
1曾文歆、1廖建華、2黃志強、2王憲奕、2甘偉志、1黃冠華
奇美醫學中心 1外科部 泌尿外科
2內科部 腎臟科
Nephroscope-assisted catheter insertion for pelvic drainage during the removal of a dialysis catheter decreases the risk of intra-abdominal complications in refractory peritoneal dialysis-related peritonitis.
Wen-Hsin Tseng1、Alex Chien-Hwa Liao1 、Jyh-Chang Hwang2、Hsien-Yi Wang2、Wei-Chin Kan2、Steven K. Huang1
1Division of Urology, Department of Surgery, 2Division of Nephrology, Department of Internal Medication, Chi Mei Medical Center, Tainan, Taiwan
Purpose:
Peritoneal dialysis (PD) is a method of renal replacement therapy in patients with end-stage kidney disease, and the most common one is continuous ambulatory peritoneal dialysis (CAPD). Peritonitis is the leading complication of PD and the major predisposing factor is PD catheter-related infection. Removal of the PD catheter is often required when patients have refractory PD-related peritonitis. Some reports show that more than 10% of patients with refractory peritonitis experience loculated ascites requiring percutaneous drainage and up to 30% of them die within 6 weeks of follow-up. This information provides evidence supporting that pelvic drainage occurred during removal of the dialysis catheter. Herein, we introduce a different method of nephroscope-assisted catheter insertion for pelvic drainage during removal of a dialysis catheter.
Materials and Methods:
From November 2013 to August 2016, eighteen patients with refractory PD-related peritonitis received a nephroscope-assisted catheter insertion for pelvic drainage during removal of the dialysis catheter by a single surgeon at Chi Mei Medical Center. Clinical data were reviewed retrospectively.
Results:
Eighteen patients were enrolled in this study, including 8 males and 10 females. The mean duration of operation was 60 minutes. There were no perioperative or postoperative complications. Catheters were removed 6 -20 days (10.81 ± 5.7) after the operation. No patient need further percutaneous drainage or open laparotomy.
Discussion:
This method of nephroscope-assisted catheter insertion for pelvic drainage during removal of the dialysis catheter was safe, easily performed, had decreased possible peritoneal complications, and permitted access to check intra-abdominal conditions.
Conclusion:
Nephroscope-assisted catheter insertion for pelvic drainage during removal of a dialysis catheter decreases the risk of intra-abdominal complications in refractory PD-related peritonitis.