One-Stage Removal and Replacement of Tract-Infected Catheter in Continuous Ambulatory Peritoneal Dialysis Patients

以壹階段步驟拔管與植管處置被感染的腹膜透析導管

蕭維強(Wei-Chiang Hsiao) ； 洪崇傑(Chung-Jye Hung) ； 黃建鐘(Jeng-Jong Huang) ； 李伯璋(Po-Chang Lee)

《Formosan Journal of Surgery》 38卷4期 (2005/08) Pp. 159-164

https://doi.org/10.29833/FJS.200508.0001

摘要

導管引發的感染是腹膜透析病患常見的感染併發症。外科處置腹膜透析導管感染包括：(1) 同時拔管及植管的壹階段步驟治療，(2) 先拔管、等待一段時間再植管的二段式手術。我們回顧1994至2003年間，在成功大學醫學院附設醫院接受手術治療替換感染的腹膜透析導管之案例，比較這二種處置方法的臨床特性與結果。在1997年以前，我們是以二段式手術治療病人，自1997後，我們主要以壹階段步驟治療出口(exit-site)／隧道(tunnel)感染病人，但以傳統二段式手術方法處置併發腹膜炎病患。故在此研究期間內，進行同時拔管及植管的手術，共計10位病患，其中包括8位出口感染者及2位隧道感染者；另外10位病患則接受傳統的二段式手術，其中包括5位出口／隧道感染者及5位併發腹膜炎者，植入新管術後，以血液透析取代10天，繼續追蹤至少三個月並評估成效。結果顯示，接受同時拔管及植管的病人，在年齡、術前施予抗生素長短及臨床預後與接受傳統的二段式手術者並無顯著差異。然而，在重回腹膜透析前的替代性血液透析時間，在接受同時拔管及植管組為10.0±0.0天，顯著短於傳統的二段式手術組中的出口／隧道感染者31.2±8.4天(P=0.001)，或併發腹膜炎者56.2±12.3天(P=0.001)。因此，我們總結同時拔管及植管的壹階段手術在處置出口／隧道感染者，可得滿意的結果，且比二段式手術縮短替代性血液透析的時間，病人可以較快回到腹膜透析。此手術用以處置連續性活動式腹膜透析病患感染之導管可能是安全可行的。

並列摘要

Objective: Catheter-related infections represent a primary infectious complication in patients with continuous ambulatory peritoneal dialysis (CAPD). A one-stage operation or two-stage procedure can be taken to remove and replace the infected catheter in CAPD patients. We retrospectively compared clinical features and outcomes between two surgical groups between 1994 and 2003 at National Cheng Kung University Hospital.
Methods: We performed the two-stage procedure to replace infected catheter before 1997. In 1997, we began to adopt a one-stage surgical procedure to treat CAPD patients who had exit-site (ES) or tunnel (T) infections, but the conventional two- stage operation was performed for patients with peritonitis. During this study period from 1994 to 2003, 10 patients received the one-stage operation (eight with ES infection and two with T infection) while the other 10 patients (five with ES/T infections and five with peritonitis) received the two-stage procedure. After insertion of new catheters, the patients underwent substitutive hemodialysis therapy for 10 days prior to restarting CAPD and were subsequently followed up for at least three months.
Results: The patients receiving the one-stage operation showed no significant differences in the mean age, duration of antibiotic therapy prior to operation, and clinical outcome as compared with those receiving the two-stage procedure. The interval for substitutive hemodialysis therapy prior to restarting CAPD was 10.0±0.0 days for patients in the one-stage group. In the two-stage group, the mean durations of substitutive hemodialysis therapy were 31.2±8.4 days (P=0.001) for patients with ES/T infections and 56.2±12.3 days (P=0.001) for those with peritonitis, which were longer as compared with that in the one-stage group.
Conclusion: The one-stage operation seemed to yield satisfactory results in treatment of CAPD patients with ES/T infections, and shortened the interval for substitutive hemodialysis, thus allowing an early return to CAPD as compared with the conventional two-stage surgery. It is more practical and may also be safe to use the one-stage operation to treat tract-infected catheter in CAPD patients.

並列關鍵字

continuous ambulatory peritoneal dialysis ； catheter-related infection ； one-stage surgery