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腹膜透析导管的放置与维护

Author
Jean L Holley, MD, FACP
Section Editor
Thomas A Golper, MD
Deputy Editors
Alice M Sheridan, MD
Kathryn A Collins, MD, PhD, FACS
Translators
李贵森, 主任医师，教授

引言

腹膜透析(peritoneal dialysis, PD)导管的主要功能是：在不需要特别努力或不引起过度不适的情况下，允许透析液持续双向流动[1]。导管的功能取决于其设计、置入部位及用于进行透析交换的系统结构。

大多数导管是柔性管，其远端(腹内)节段有多个开孔，该段在理想状况下被游离地放置于腹内骨盆区。导管的中央部分通常通过1-2个涤纶丝绒套植于腹壁内。对于双套导管，深部套置于腹直肌内；双套和单套导管的浅表套均放置于皮下距腹壁上导管出口部位约2cm处。

PD导管的放置和维护将总结在此。在讨论这些问题之前，简要介绍一下现有的不同类型透析导管会有所帮助。与这些导管相关的并发症将单独讨论。 (参见“腹膜透析管的非感染性并发症”)

导管的类型

目前有多种类型的导管可用于长期PD(图 1)。Tenckhoff双套直管是一种腹内部分直行的(相对于卷曲管而言)硅胶管，为常用的导管[1-3]。Missouri天鹅颈管与Toronto Western导管也已被广泛使用[4]。无论导管的类型如何，1年时总体导管留存率约为88%，移除率为每年15%[3,5,6]。

前瞻性随机试验尚未最终证实某种导管的获益优于另一种导管[3,5-9]。例如，一篇2004年发表的系统评价发现，直管与卷曲管相比，或者单套与双套导管相比，在预防腹膜炎方面都无差异，但直管的全因死亡率较低(RR 0.26，95%CI 0.07-0.99)[7]。

                 

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Literature review current through: 2017-06 . | This topic last updated: 2017-07-12.
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