| 摘要 |
Objective: Catheter-related infections represent a primary infectious complication in
patients with continuous ambulatory peritoneal dialysis (CAPD). A one-stage operation
or two-stage procedure can be taken to remove and replace the infected catheter
in CAPD patients. We retrospectively compared clinical features and outcomes
between two surgical groups between 1994 and 2003 at National Cheng Kung
University Hospital.
Methods: We performed the two-stage procedure to replace infected catheter before
1997. In 1997, we began to adopt a one-stage surgical procedure to treat CAPD
patients who had exit-site (ES) or tunnel (T) infections, but the conventional twostage
operation was performed for patients with peritonitis. During this study period
from 1994 to 2003, 10 patients received the one-stage operation (eight with ES
infection and two with T infection) while the other 10 patients (five with ES/T infections
and five with peritonitis) received the two-stage procedure. After insertion of
new catheters, the patients underwent substitutive hemodialysis therapy for 10 days
prior to restarting CAPD and were subsequently followed up for at least three
months.
Results: The patients receiving the one-stage operation showed no significant differences
in the mean age, duration of antibiotic therapy prior to operation, and clinical
outcome as compared with those receiving the two-stage procedure. The interval for
substitutive hemodialysis therapy prior to restarting CAPD was 10.0±0.0 days for
patients in the one-stage group. In the two-stage group, the mean durations of substitutive
hemodialysis therapy were 31.2±8.4 days (P=0.001) for patients with ES/T
infections and 56.2±12.3 days (P=0.001) for those with peritonitis, which were longer
as compared with that in the one-stage group.
Conclusion: The one-stage operation seemed to yield satisfactory results in treatment
of CAPD patients with ES/T infections, and shortened the interval for substitutive
hemodialysis, thus allowing an early return to CAPD as compared with the conventional
two-stage surgery. It is more practical and may also be safe to use the one-stage
operation to treat tract-infected catheter in CAPD patients. |
