Hernia in Esrd Patients Receiving Peritoneal Dialysis

對於末期腎衰竭病人，除了血液透析外，腹膜透析亦為同樣有效的腎臟替代療法，並已逐漸為病患所接受，在腹膜透析病患的機械式併發症，疝氣並不罕見。我們設計這一個回溯性的研究以分析本中心的腹膜透析患者罹患不同種型式的疝氣之盛行率及相關的預後。從1992年1月至2002年8月，在我們中心共有235位（84位男性，151位女性）末期腎衰竭患者曾接受腹膜透析治療（5,266人月），其中有14位患者罹患疝氣。我們比較分析了這些疝氣病人與其它未發生疝氣的221位腹膜透析患者的臨床資料及實驗室數據。在14位患者（6%）中分別有7位男性及7位女性，共發生了14次疝氣；其中，臍疝氣5例，腹股溝疝氣7例及腹疝氣2例。在這些病人之中，有半數的疝氣是發生於植入導管後前七個月內。七位病人在疝氣發生之時，即接受外科修補手術。這七位病人中，6位繼續接受腹膜透析，只有一位轉為血液透析。其餘未接受手術治療的疝氣患者則以減少透析液填充量、改為自動腹膜透析以及使用束腹帶來治療。這些病人在悉心照護之下，並沒有發生腸箝閉的併發症。我們並且將年齡、性別、植入導管的類型和填充之透析液量等危險因子以及糖尿病和先前的腹部手術史等相關罹病率列入統計分析。然而，在我們的病人之中，並未發現在統計中有意義的、與疝氣的發生有關危險因子。因此，就我們的臨床經驗顯示，早期發現以及細心的照顧，包括非外科方法，可以讓疝氣患者繼續以腹膜透析作為腎臟替代療法。

關鍵字

疝氣；機械性併發症；腹膜透析

並列摘要

Peritoneal dialysis (PD) is a well-established treatment modality for end-stage renal disease (ESRD) and is gaining popularity as a home dialysis therapy. Hernia, a mechanical complication, is not uncommon in patients on PD. This retrospective study was designed to investigate the prevalence of different types of hernias and related outcomes in all ESRD patients on peritoneal dialysis (PD) at our institution. Between January, 1992 and August, 2002, a total of 235 ESRD patients (84 male, 151 female) at our center were treated with PD at our center over 5266 patient-months. The clinical and laboratory parameters of 14 patients who developed hernias were compared with that of 221 patients who did not develop hernias. Fourteen patients (6%), 7 male and 7 female, developed 14 hernias, of which 5 were umbilical, 7 inguinal, 2 ventral. Half of the hernias in our cohort developed within the first seven months following catheter implantation. Seven patients received surgical repair as hernia developed within the first seven months following catheter implantation. Seven patients received surgical repair as hernia developed, of which six patients resumed PD and only one shifted to hemodialysis. The remaining hernias were managed with volume reduction, conversion from CAPD to automated PD and mechanical support with corset. None of the patients with hernia developed incarceration after careful management. Risk factors including age, sex, types of catheter, fill-volumes and co-morbidities as DM, and previous operations were statistically analyzed. However, none of them seemed to have a predisposing factor for hernia formation in our cohort. With early detection and careful management including non-surgical methods, patients with hernias may be maintained on peritoneal dialysis.

並列關鍵字

hernia ； mechanical complications ； peritoneal dialysis

國際替代計量

Hernia in Esrd Patients Receiving Peritoneal Dialysis

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