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持续性腹膜透析中的腹壁疝

Authors
Michael Rocco, MD, MS
John M Burkart, MD
Section Editor
Thomas A Golper, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
李俊生, 主任医师，副教授

引言

在行持续性腹膜透析(peritoneal dialysis, PD)的患者中，腹壁疝是一个重要问题[1]。本专题将讨论腹膜透析患者中的腹壁疝。

发病率

在二十世纪80年代早期，腹壁疝的年发病率为10%-15%。从历史经验来看，间歇性门诊腹膜透析者的腹壁疝发病率较持续性门诊腹膜透析者低，前者的腹壁疝年发病率低于5%[2]。

由于后来采用中线旁途径插入腹膜透析管这一技术改良，导管出口疝及切口疝的发病率显著降低[3,4]。据报道，当前疝的年发病率为0.04-0.08/患者[1,5,6]。

疝形成的危险因素

关于疝形成的危险因素，各项研究存在争议[4-7]。美国的一项大型研究纳入了1864例腹膜透析患者，结果显示，疝形成与患者年龄、体表面积、腹膜透析方式、透析液量、采用最大留腹量的时间和所用导管的种类均不相关。囊性疾病使得解剖相关并发症的发生风险增加了1.5倍；患者为女性时疝形成风险降低了80%，Kt/V大于等于2.0使得疝形成风险降低了52%(P<0.05)[7]。从病理生理学角度来看，这些危险因素反映了可影响疝形成的解剖因素、流体静压因素或代谢因素。

解剖部位 — 容易发生疝的解剖薄弱部位包括：腹股沟管、脐、白线、未闭合的鞘状突、导管出口处和既往手术切口处 。比如，睾丸通过鞘状突下降到阴囊，随后鞘状突应闭合。然而，刚出生的婴儿中有90%鞘状突未闭，并且尸检发现，没有疝的成人中高达37%也存在鞘状突未闭。腹腔液漏入未闭合的鞘状突可导致腹股沟斜疝的形成。

           

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Literature review current through: 2017-06 . | This topic last updated: 2016-03-14.
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