彩色多普勒超声测定腹膜厚度在评估腹膜硬化中的意义

应用彩色多普勒超声(彩超)检测腹膜厚度,了解腹膜状态及硬化程度的报道甚少.我们对15例腹膜透析(PD)患者进行彩超检测腹膜厚度并分析如下.     

腹膜透析对水通道蛋白3在大鼠腹膜组织表达的影响

腹膜超滤衰竭(UFF)是长期腹膜透析的主要并发症,腹膜水转运特性发生改变将会导致超滤衰竭的发生.有报道称水通道蛋白家族成员之一AQP3不仅选择性通透水,而且高通透甘油和尿素,在腹膜溶质转运方面发挥着重要的作用.     

后腹膜黏液性囊腺瘤的诊治

黏液性囊腺瘤多见于卵巢、胰腺和阑尾等部位,发病于后腹膜者极为罕见.笔者最近手术1例右侧后腹膜巨大黏液牲囊腺瘤,查阅国内文献得6例类似病例报道[1-6],总结报道如下.     

腹膜粘连形成及防治的新进展(文献综述)

自1853年Virchow首次报道腹膜粘连以来,对腹膜粘连的防治已予极大的重视.然而大部分腹腔手术后,几乎不可避免地有腹膜粘连的形成.Weibel尸解298例生前曾施行剖腹术者,有67%发生腹膜粘连,其中复杂手术腹膜粘连发生率高达93%.Ellis曾对50例有剖腹术史的患者进行再次手术,发现44例有腹膜粘连形成.由于腹腔、盆腔手术愈趋普遍,因腹膜粘连导致腹部疼痛、不孕等各种併症均有报道.Triotski发现腹膜粘连可成为腹部肿瘤最早的转移途径.腹膜粘连是引起肠梗阻最常见的病因.Perry     

特发性腹膜后纤维化

腹膜后纤维化 (ｒｅｔｒｏｐｅｒｉｔｏｎｅａｌｆｉｂｒｏ ｓｉｓ,ＲＰＦ)是一种以腹膜后纤维脂肪组织增生为特征的非特异性非化脓性炎症 ,引起腹膜后广泛纤维化 ,使腹膜后空腔脏器受压而发生梗阻。该病累计报道大约 10 0 0例左右 ,以白种人多见 ,我国人相当少见 ,国内公开报道不超过 5 0例。Ｋｏｅｐ等报道大约 1/ 3ＲＰＦ病例的病因与某些药物、肿瘤、外伤等因素有关 ,称为继发性腹膜后纤维化 ;2 / 3的病例病因未明称为特发性腹膜后纤维化(ＩＲＦ)。而ＩＲＦ诊断困难 ,病理上有全身多灶性倾向 ,治疗意见欠一致 ,因此将近年来有关文献作一…     

腹膜后巨大神经鞘瘤并双下腔静脉一例报告

腹膜后神经鞘瘤是一种较少见的腹膜后神经鞘源肿瘤,双下腔静脉亦是少见的下腔静脉变异.腹膜后神经鞘瘤同时合并双下腔静脉的病例,目前国内、外尚无报道.现将这一罕见病例的临床表现、诊断及手术切除报道如下.     

创伤性腹膜后血肿临床诊治体会

腹膜后血肿是由于腹膜外位和间位脏器的损伤及位于腹腔内大血管和肌肉骨骼结构等损伤所致.腹部外伤时腹膜后血肿的发生率占腹部外伤的13%～44%.由于其多伴有脏器损伤,且临床表现主要反映腹膜后脏器损伤及其他部位的损伤,易被忽视,病死率为19%～39%[1].我院2000年至2006年共收治腹膜后血肿102例,现将诊治体会报道如下:     

中药腹腔给药对腹膜结构和腹膜透析的影响

根据肾病一体化治疗模式,腹膜透析目前已经广泛应用于终末期肾脏疾病的替代治疗.近年来关于如何提高腹膜透析效率、增加腹透液生物相容性、防止腹膜纤维化、加强腹膜局部防御功能的研究始终受到肾科临床医生的关注,研究的内容主要是改变腹透液渗透剂、缓冲液的配方或是在腹透液中加入一定的药物.在腹透液中加入中药制剂的临床和实验研究也屡见报道,目前研究的药物主要集中在益气和活血类的中药,包括黄芪、丹参、川芎、当归和人参.兹就近年来主要的研究综述如下.     

腹膜透析相关腹膜纤维化机制的研究进展

腹膜透析是终末期肾脏病患者替代治疗的方法之一,腹膜纤维化是导致长期腹膜透析患者最终退出腹膜透析的主要原因之一.腹膜纤维化的发生主要与非生理性的腹膜透析液、腹膜炎、糖基化代谢产物有关,近年来有关腹膜纤维化发生机制的研究也越来越多,我们着重分析肾素－血管紧张素－醛固酮系统及多种生长因子在腹膜纤维化过程中的作用机制,以期为探讨更有效地防治腹膜纤维化的方法提供依据.     

创伤性骨盆区腹膜后血肿的诊治体会

创伤性骨盆区腹膜后血肿是骨盆骨折及腹膜后器官损伤的主要并发症之一,往往合并复杂的腹部闭合伤,处理困难,病死率高.近十余年我院共收治53例患者,总结报道如下.     

Phosphatidylcholine and peritoneal transport during peritoneal dialysis

Peritoneal effluent of patients on chronic ambulatory peritoneal dialysis (CAPD) contains a surface-active material (SAM) made up of phospholipids and showing phosphatidylcholine on thin-layer chromatography. This substance drastically lowers surface tension, helps to repel water and has a lubricating effect. The presence of stratified phosphatidylcholine on the peritoneum might narrow the stagnant dialysate fluid layer and situations which can alter the quantity or composition of SAM may affect peritoneal transport and also, perhaps, the formation of adherences. This led us to verify, experimentally, the presence of phospholipids in basal conditions, after CAPD and during peritonitis and to check if addition of phosphatidylcholine to dialysis liquid is able to modify water transport in patients with low ultrafiltration and peritonitis. Phospholipids in the dialysis effluent of patients who have been on CAPD for a long time are lower than observed in the first days of peritoneal dialysis. A more drastic, significant decrease in phospholipids was observed in patients with low ultrafiltration and in patients with peritonitis. Mean ultrafiltration significantly increases in patients with low ultrafiltration and in those with peritonitis during dialysis exchanges containing phosphatidylcholine (50 mg/l) indicating that the latter is able to restore normal physiological conditions.     

Encapsulating peritoneal sclerosis in paediatric peritoneal dialysis patients

Encapsulating peritoneal sclerosis (EPS) is a serious complication of chronic peritoneal dialysis (CPD). In contrast to the adult population, there are few studies regarding EPS in paediatric CPD patients, and the majority of reported patients are from Japan. The aim of the present report is to define the incidence of EPS in our paediatric CPD patients and to describe the clinical and laboratory characteristics. A total of 104 paediatric patients were followed from November 1989 to November 2003 and two were diagnosed as EPS (1.9%). The dialysis periods of these patients were 45 and 53 months with 6 and 8 peritonitis episodes, respectively. Clinical signs of EPS developed 7 and 14 days after the removal of the dialysis catheter, and CPD was replaced by haemodialysis because of persistent peritonitis. One patient was well after surgical management but died 6 months later. The second patient who was treated with prednisolone remained well at 16 months. In conclusion, EPS is a rare but important complication of CPD. We recommend that all patients on CPD who develop ultrafiltration failure be evaluated radiologically for the occurrence of EPS. Management should be tailored to the individual patient.     

黄芪改善腹透患者腹腔巨噬细胞功能的临床研究

目的：研究黄芪对尿毒症患腹腔巨噬细胞功能的影响。方法：对43例尿毒症初始行腹膜透析的患在腹透液中不加（对照组）和加入黄芪注射液（用药组）治疗1周,用ELISA法检测观察前后腹腔巨噬细胞分泌TNF－a能力和吞噬功能的变化。结果：黄芪用药组腹腔巨噬细胞吞菌率、吞噬指数、杀菌率和巨噬细胞分泌TNF－a水平和对照组相比均明显上升（P＜0．01）,巨噬细胞分泌TNF－a水平与用药前自身对比也显提高（P＜0．05）。结论：腹透液中加入黄芪注射液可提高腹透患腹腔巨噬细胞功能。     

The short peritoneal equilibration test in pediatric peritoneal dialysis

The peritoneal equilibration test (PET) is the gold standard method for defining peritoneal membrane permeability and for prescribing peritoneal dialysis (PD) therapy on an individual basis. However, it is laborious, consumes nursing time, and requires many hours to be performed. Therefore, several authors have attempted to validate a short PET protocol, with controversial results. To evaluate the concordance between the 2-h (short) and 4-h (classical) peritoneal equilibrium test, a prospective observational protocol was applied in three PD centers (Mexico, Chile, and Uruguay) between July 1, 2008 and July 31 2009. PET protocol: the night prior to the test, each patient received five exchanges, 1 h each, at the same glucose concentration as previously used. Afterwards, a 2.5% glucose dialysis solution was used for a dwell time of 4 h. Exchange fill volume was 1,100 ml/m² body surface area. The next morning, the 4-h dwell was drained, and Dianeal 2.5% was infused. Three dialysate samples at 0, 2, and 4 h were obtained. A single blood sample was obtained at 120 min. Creatinine D/P and glucose D/D₀ ratios were calculated at hours 0, 2, and 4. Patients were categorized as low, low average, high average, or high transporters according creat D/P and gluc D/D₀ results. Pearson and Kappa test were used for numerical and categorical correlations, respectively, and p?<?0.05 was considered significant. Eighty-seven PET studies were evaluated in 74 patients, 33 males, age 11.1?±?5.05 years old. A positive linear correlation of 92% between 2 and 4-h creat D/P and 80% between 2 and 4-h gluc D/D₀ (p?<?0.001) was founded. The Kappa test showed a significant concordance between creat D/P and gluc D/D₀ categories at 2 and 4 h (p?<?0.001). When analyzing cut-off-value categories, creat D/P was founded to be lower and gluc D/D₀ higher than other experiences. This multicentric prospective study strongly suggests that PET obtained at 2 h and 4 h, based on either creatinine or glucose transport, provides identical characterization of peritoneal membrane transport capacity in PD children.     

Long-term peritoneal dialysis and encapsulating peritoneal sclerosis in children

Encapsulating peritoneal sclerosis (EPS) is the most serious complication of long-term peritoneal dialysis (PD), with a mortality rate that exceeds 30%. There have been many reports of the incidence of EPS being strongly correlated to the duration of PD. Patients on PD for longer than 5 years, and especially those receiving this treatment for more than 8 years, should undergo careful and repeated surveillance for risk factors associated with the development of EPS. The development of ultrafiltration failure, a high dialysate/plasma creatinine ratio, as determined by the peritoneal equilibration test, peritoneal calcification, a persistently elevated C-reactive protein level, and severe peritonitis in patients on PD for longer than 8 years are signals that should prompt the clinician to consider terminating PD as a possible means of preventing the development of EPS. The impact of the newer, biocompatible PD solutions on the incidence of EPS has not yet been determined.     

Adrenomedullin in peritoneal effluent expressed by peritoneal mesothelial cells

Background

Adrenomedullin (AM) possesses vasodilative and cell-protective properties. Glycine combines with the C-terminal of AM to form mature, physiologically active AM (mAM). AM is reportedly induced by high glucose condition in vascular endothelial or smooth muscle cells; however, little is known on how AM is activated by amidation. To investigate the behavior of AM in patients undergoing peritoneal dialysis (PD), the concentrations of AM, mAM and CA125 were measured. The mAM to AM ratio (mAM/AM ratio) was also evaluated as a marker of amidation activity.

Methods

Twenty patients were recruited for this study. The effluent at the time of the peritoneal equilibration test was collected and AM, mAM and CA125 concentrations were measured. The expression of AM in peritoneal mesothelial cells (PMCs) collected from effluent was also examined with an indirect immunofluorescent method.

Results

Mean values of AM and mAM in effluent were 18.1 ± 1.6 and 4.1 ± 0.3 fmol/mL, respectively. In plasma, they were 42.6 ± 3.3 and 5.6 ± 0.6 fmol/mL, respectively. AM concentrations in effluent did not correlate with plasma AM level but correlated well with the dialysate-to-plasma ratio of creatinine (D/P ratio of creatinine). Moreover, in 7 of 20 cases, concentrations of the mAM and mAM/AM ratio in effluent were higher than in plasma. In effluent, AM concentration but not the mAM/AM ratio correlated with CA125 concentration. Immunocytological study revealed diffuse, cytoplasmic expression of AM in PMCs which were collected from effluent during PD.

Conclusion

AM is expressed by PMCs and actively amidated in the abdominal cavity of patients undergoing PD.