Safety and utility of the alpha replacer for treatment of intraluminal obstruction of peritoneal catheters by fibrin clots.
Safety and utility of the alpha replacer for treatment of intraluminal obstruction of peritoneal catheters by fibrin clots.
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α 替代物治疗纤维蛋白凝块引起的腹膜导管管腔内阻塞的安全性和实用性。
DOI：
10.1007/s10157-020-02001-8
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Ito Y.
中科院分区：
文献类型：
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作者：
Asai A;Kinashi H;Suzuki Y;Kojima H;Sato Y;Matsuoka N;Asai N;Kuroyanagi Y;Yamaguchi M;Nobata H;Katsuno T;Ishimoto T;Mizuno M;Ito Y.
Moncrief-Popovich腹膜导管置入技术对腹膜透析(PD)的启动有良好的效果。然而，这可能会增加腹膜导管被纤维蛋白凝块阻塞的风险，因为导管被埋在皮肤下几周到几个月。据报道，国际腹膜透析学会指南/建议推荐的组织纤溶酶原激活剂治疗帕金森病导管腔内闭塞的效果有限。我们调查了日本东京JMS公司生产的“α-替换物”对PD导管阻塞的疗效。其中130例患者使用Moncrief-Popovich技术植入PD导管。结果8例置入导管的患者中，1例为大网膜包裹，1例为纤维蛋白凝块所致，中位埋管时间为477天(四分位数范围226~510天)。所有因纤维蛋白凝块引起的导管阻塞都成功地用阿尔法替代器治疗，从而改善了导管引流。造影中使用的造影剂中位量为10(IQR9-10)毫升，不会对残余肾功能产生不利影响。无并发症发生。观察期内(中位数111个月，IQR 55.5~141个月)无复发。结论α-替代物是治疗纤维蛋白凝块致PD导管腔内阻塞的一种安全有效的治疗方法。
BackgroundThe Moncrief-Popovich technique of peritoneal catheter implantation has beneficial effects for peritoneal dialysis (PD) initiation. However, it might increase the risk of peritoneal catheter obstruction by fibrin clots, because the catheter is buried under the skin for several weeks to months. Effects of treatment of intraluminal occlusion of PD catheters with tissue plasminogen activator, recommended by the International Society for Peritoneal Dialysis guidelines/recommendations are reportedly limited. We investigated the effectiveness of the ‘alpha-replacer’ (JMS, Tokyo, Japan) for PD catheter obstruction.MethodsWe retrospectively analyzed a total of 193 patients in whom PD was initiated. PD catheters were embedded using the Moncrief-Popovich technique in 130 of these patients. We assessed the occurrence rates of peritoneal catheter obstruction and the utility of the alpha-replacer for treating intraluminal catheter occlusion by fibrin clots.ResultsCatheter obstruction occurred in eight cases with embedded catheters, one due to omental wrapping and the others due to fibrin clots, in which median catheter burial durations were 477 (interquartile range [IQR], 226–510) days. All catheter obstructions due to fibrin clots were successfully treated with the alpha-replacer, leading to improved catheter drainage. The median amount of contrast agent used in catheterography was 10 (IQR 9–10) mL, which did not adversely affect residual renal function. There were no complications. No recurrence occurred during the observation period (median 111, IQR 55.5–141 months).ConclusionOur results suggest that treatment with the alpha-replacer is a safe and effective treatment option for intraluminal obstruction of PD catheters by fibrin clots.