Dialysate Leakage in Chronic Peritoneal Dialysis Patients

腹膜透析之透析液滲漏

陳勇志(Yung-Chih Chen) ； 吳麥斯(Mai-Szu Wu) ； 李進昌(Ching-Chang Lee) ； 林玉英(Yu-Ying Lin) ； 陳玉惠(Yu-Hui Chen) ； 林志郎(Chih-Lang Lin)

《Acta Nephrologica》 17卷2期 (2003/05) Pp. 69-75

摘要

背景：腹膜透析液滲漏是腹膜透析病人所發生重要的併發症之一，其文獻報告的結果多所歧異。
研究目的：研究腹膜透析液滲漏的發生率，臨床特徵，診斷及預後。
方法：我們回溯探討由1995年5月到2004年3月共232個接受腹膜透析的病人，平均植管年齡為52.0±15.7歲。我們記錄這些病人慢性腎衰竭的病因、性別、植管年齡、體重、導管植入方法，透析液注入時間和體積，腹膜透析方式，臨床表現，滲漏的部位，腹膜透析時間長短，危險因子和預後。針對透析液滲漏和未滲漏之腹膜透析病人的臨床資料，如以分析比較。
結果：共有12個病人發生不同型式的透析液滲漏，發生率約為5.2%。平均植管年齡為49.7±13.4歲。平均腹膜透析時間約為9.7±11.2個月。發生透析液滲漏的病人比沒有透析液滲漏的病人有較重的平均體重，較高比例有腹部手術史及高血壓。發生透析液滲漏的病人中有5例鼠蹊部滲漏，4例肋膜積水，2例皮下組織滲漏和1例導管出口旁滲漏。其中只有4位病人接受手術治療（3例鼠蹊部滲漏，1例皮下組織滲漏）。最後，有5例病人轉而接受備註透析（4例肋膜積水，1例鼠蹊部滲漏）。
結論：我們研究顯示腹膜透析液滲漏發生率底。透析液滲漏較常見於體重較重，有腹部手術史及高血壓的病人。除了肋膜積水外的透析液滲漏的病人接受適當的治療後可繼續接受腹膜透析治療。

關鍵字

透析液滲漏 ； 腹膜透析 ； 肋膜腔積水 ； 陰囊水腫

並列摘要

Background: Peritoneal dialysate leakage is one of the major complications of peritoneal dialysis (PD). Reported clinical characteristics of this complication have shown diverse results.
Aims of the study: To study the incidence, clinical characteristics, diagnosis and prognosis of dialysate leakages.
Patients and methods: We conducted a retrospective study, reviewing 232 PD patients undergoing treatment from 1991 to 2004. The mean age was 50.1±15.7 years-old. All patients' etiologies of ESRD, gender, age, body weight when starting PD, catheter insertion techniques, break-in periods, dialysate fill volumes, PD modalities, initial presentations, sites of leakages, PD durations, risk factors and prognoses were reviewed.
Results: 12 patients were enrolled with an incidence of dialysate leakage about 5.2%. The mean age was 49.7±13.4 years-old, and mean PD duration was 9.7±11.2 months. Patients with dialysate leakage had higher body weights, previous abdominal surgeries and greater incidence of hypertension than did non-leakage patients. There were 5 inguinal, 4 pleural, 2 subcutaneous and 1 pen-catheter leakages. Four patients received surgical intervention (3 hydrocele, 1 subcutaneous leakage). Dialysate leakage induced 5 patients to leave the PD program (4 cases of pleural effusions and 1 case of hydrocele).
Conclusion: Our study indicated that there is a low incidence of dialysate leakage in our PD population. However, dialysate leakage is more common in patients with higher body weights, previous abdominal surgeries and hypertension. Most of the patients with dialysate leakage (88%, 7/8), excluding those patients with pleural leakage, stayed in the PD program after appropriate therapy.

並列關鍵字

dialysate leakage ； peritoneal dialysis ； pleural effusion ； and hydrocele