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계속적 외래복막투석에서 도관기능부전시 도관제거에 앞서 도관기능 회복을 위한 처치
방종효(Jong Hyoo Bang),김준홍(Jun Hong Kim),조성(Seong Cho),권태환(Tae Hwan Kwon),김용림(Yong Lim Kim),조동규(Dong Kyu Cho) 대한내과학회 1996 대한내과학회지 Vol.50 No.4
Objectives: The peritonitis and peritoneal catheter malfunction remained as two major causes for the failure of chronic peritoneal dialysis. Extensive quantitative data on the nonoperative technique alternative to surgical placement of a new catheter in catheter malfunction due to dislodgment and obstruction are not available. Methods: From January 1991 through February 1993, thirteen fluoroscopy guided brushings and twelve laparoscopy guided manipulations were performed for 15 adult patients with catheter malfunction due to dislodgment and obstruction in an effort to prolong catheter life. Results : 1) The causes of catheter malfunction were four omental wrapping with secondary migration, four obstruction by fibrin deposits or blood clots, and seven dislodgment and obstruction. 2) With fluoroscopy guided brushing and/or laparoscopy manipulation, catheter malfunction were restored in 11 patients(73%). Among 11 patients, catheter malfunction were restored in 4 patients with fluoroscopy guided brushing, 4 patients with laparoscopic manipulation, and 3 patients with combination of two procedures. However, the remaining four patients, even after repeated manipulations, ended with catheters removal due to persistent malfunction. Eight patients had immediately successful restoration of catheter malfunction at the time of the procedure, two patients in the first week, and one patient in the third week. 3) There were four complications followed by the procedure : two were CAPD peritonitis and exit site infection and leakage followed by fluoroscopy guided brushing, and the other were laparoscopy related leakage from puncture site which was recovered by resting for two weeks and a broken catheter tip within peritoneal cavity which could be removed safely by laparoscopy. Conclusion: Fluoroscopy or laparoscopy guided manipulation of catheter was considered as re- commendable techniques in the catheter malfunction and could also be a desirable alternative to surgical placement of a new catheter.
지속성 외래복막투석환자에서 조기 및 후기 복강 관류액 누출
김진홍,조동규,권태환,김용림,방종효,조성 대한신장학회 1995 Kidney Research and Clinical Practice Vol.14 No.3
Continuous ambulatory peritoneal dialysis(CAPD) is now a well-established mode of therapy for end- stage rena@l disease. Dialysate leaks as well as other technical complications, however, still remain as an important complication of CAPD. The dialysate leaks may develop early after catheter implantation(early leaks), or months or even years later(late leaks). In either case, the leak may stop if peritoneal dialysis is discontinued for a period ranging from two days to three weeks. From January 1988 through August 1994, 201 CAPD patients were analyzed retrospec- tively. Twenty six patients developed early leaks (within 30 days of catheter insertion) and 9 patients late leaks(beyond 30 days of catheter insertion). The incidences of early and late leaks were 12.9% and 4.5% respectively. Most early leaks were manifested externally through the exit site, but late leaks usually by poor dialysate outflow, localized edema and/or subucutaneous fluid collection. Concurrent complications of the early and late leaks were mainly CAPD peritonitis and exit site infection. The catheter removal rates of early and late leaks were 3.8% and 33.3% respectively. Early leaks were su- ccessfully managed by 2 weeks' discontinuation of CAPD alone in most cases. In late leaks, our experience does suggest that catheter removal will be required if leakage continues beyond 96 hours. Early leaks differ from late leaks in some clinical manifestations and are successfully managed by temporary discontinuation of CAPD. Late leaks are an uncommon and unpredictable complication of CAPD and resulted frequently in replacement of peritoneal catheters. Excessive exercise or mechani- cal manipulation of catheter might result in the occurrence of late leaks.