American Society of Diagnostic and Interventional Nephrology Section Editor: Stephen Ash: Peritoneal Dialysis Access‐Related Procedures by Nephrologists
American Society of Diagnostic and Interventional Nephrology Section Editor: Stephen Ash: Peritoneal Dialysis Access‐Related Procedures by Nephrologists
复制标题
美国诊断和介入肾病学会分会编辑：Stephen Ash：肾病专家的腹膜透析通路相关程序
作者：
A. Asif
传统上，在终末期肾病(ESRD)患者中放置腹膜透析(PD)导管是由外科医生在全身麻醉下完成的。这种方法经常导致PD开始的延迟，在使用手术室和麻醉服务方面产生额外的成本，并引入与全身麻醉相关的死亡风险。最近的数据强调，介入肾脏科医生可以安全和成功地进行PD访问程序。在这种情况下，不需要手术室设施、工作人员和麻醉服务，可以使用局部麻醉在程序室进行导管插入，从而降低成本并完全绕过与全身麻醉相关的死亡风险。当由肾脏科医生进行时，可以快速完成导管插入，并及时开始透析治疗。一旦开始，腹膜透析的成功取决于能否长期可靠地进入腹膜腔。前瞻性、随机性和非随机性研究表明，与外科置入的导管相比，肾科医生在腹腔镜处放置的PD导管的并发症(感染、出口部位渗漏)更少，导管存活率更长。尽管PD有许多优点，但它仍然是一种未得到充分利用的肾脏替代疗法。为了抵消PD的利用不足，至少有两个独立的中心已经证明，当肾病学家进行导管插入时，PD人口的增长具有积极的影响。这篇文章介绍了目前由介入肾脏科医生进行的PD通路相关操作。此外，还讨论了与PD导管插入和管理相关的一些复杂问题(肠穿孔、导管移位、既往腹部手术)。
Traditionally the placement of a peritoneal dialysis (PD) catheter in a patient with end‐stage renal disease (ESRD) has been accomplished by a surgeon and using general anesthesia. This approach often introduces delays in starting PD, incurs additional costs in utilizing an operating room as well as anesthesia services, and introduces the mortality risk associated with general anesthesia. Recent data have emphasized that interventional nephrologists can safely and successfully perform PD access procedures. In this context, operating room facilities and staff and anesthesia services are not required and catheter insertion can be performed in a procedure room using local anesthesia, thereby reducing costs and completely bypassing the mortality risk associated with general anesthesia. When performed by a nephrologist, the catheter insertion can be accomplished swiftly and dialysis therapy initiated in a timely manner. Once begun, the success of PD hinges on reliable and long‐term access to the peritoneal cavity. Prospective randomized and nonrandomized studies have shown that PD catheters peritoneoscopically placed by nephrologists have fewer complications (infection, exit site leak) and longer catheter survival rates than those inserted surgically. Although PD offers a variety of advantages, it remains an underutilized form of renal replacement therapy. To counteract PD underutilization, at least two separate centers have demonstrated a positive impact on the growth of the PD population when catheter insertion is performed by nephrologists. This article presents PD access‐related procedures currently performed by interventional nephrologists. Furthermore, some of the complicating issues (bowel perforation, catheter migration, prior abdominal surgery) related to PD catheter insertion and management are also discussed.