Six -Year Experience with Swan Neck Catheters
Six -Year Experience with Swan Neck Catheters
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六年鹅颈导管经验
DOI：
10.1177/089686089201200410
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发表时间：
1992
影响因子：
2.8
通讯作者：
R. Khanna
中科院分区：
文献类型：
--
作者：
Z. Twardowski;B. Prowant;Nichols Wk;K. Nolph;R. Khanna
从1977年1月开始的持续性非卧床腹膜透析（CAPD）项目到1985年6月，我们使用的导管是Alfrekhoff和多伦多西部医院导管。这些年来，3年时约30%的导管生存概率保持不变，与国家CAPD登记处对这些导管进行的特殊调查报告的生存概率相似。在采用侧向导管插入后，观察到泄漏方面的导管结果首次改善。从1985年8月到1986年4月，使用鹅颈原型的故障较少。后一种导管由间隔8.5 cm的套囊之间的80°弯管制成，并插入倒U形隧道中，切口位于隧道顶部。由于高套囊挤出和出口感染率，这些导管的使用被放弃。下一代天鹅颈导管，即带有直腹膜内段的天鹅颈密苏里州2和3导管，显著改善了结果。这些导管由间隔5或3 cm的套囊之间的180°成角管制成。与之前使用的导管相比，3年时的估计生存概率为61%，增加了一倍以上。最近，我们修改了腹膜内段的导管，取代直段与一个线圈。自1990年2月以来，专门使用这些改良导管，即鹅颈密苏里州盘绕导管。除了1年时88%的可接受生存概率外，这些导管还有两个主要优势，与其他盘绕导管相同：消除了由于喷射效应引起的输注疼痛和一些患者经历的与直导管头端压力对腹膜的影响相关的疼痛。
From the beginning of our continuous ambulatory peritoneal dialysis (CAPD) program in January 1977 until June 1985, we used Tenckhoff and Toronto Western Hospital catheters. Throughout these years catheter survival probabilities of about 30% at three years persisted unchanged and were similar to survival probabilities reported by the National CAPD Registry special survey for these catheters. The first improvement in catheter results regarding leaks was noted after the adoption of lateral catheter insertion. Malfunction was less using swan neck prototypes from August 1985 to April 1986. The latter catheters were made of 80° are angle tubing between 8.5 cm spaced cuffs and were inserted in a reversed U-shape tunnel with the incision at the top of the tunnel. The use of these catheters was abandoned because of high cuff extrusion and exit infection rates. The next generation of swan neck catheters, the swan neck Missouri 2 and 3 catheters with straight intraperitoneal segments, improved the results dramatically. These catheters were made of 180° are angletubing between 5 or 3 cm spaced cuffs. The estimated survival probability of 61% at three years more than doubled compared to previously used catheters. Recently we modified the intraperitoneal segment of the catheters, replacing the straight segment with a coiled one. These modified catheters, the swan neck Missouri coiled catheters, have been used exclusively since February 1990. In addition to an acceptable survival probability of 88% at one year, there are two major advantages of these catheters, the same as for other coiled catheters: elimination of infusion pain due to a jet effect and pain related to straight catheter tip pressure on the peritoneum experienced by some patients.