腹透中腹膜炎的诊疗新进展

自从使用Tenckhoff管后,腹膜透析(腹透)已被认为是一种安全有效和花费少,基层医院都可施行的透析方法。在所有腹透并发症中,细菌性腹膜炎最为严重。其不良后果主要有:①由透析而丢失的蛋白比平时增加5～10倍;②透析管堵塞;③透析的弥散和超滤效能下降;④近年,对腹膜超微结构的研究表明;反复感染,可使腹膜的间皮细胞表而微绒毛消失,细胞与基质分离。问皮层破坏甚至于完全消失,代之以纤维组织增生。本院CAPD十年总结表明,在中止CAPD诸原因中,细菌性腹膜炎占22.7%,因此,如何防治腹膜炎是腹膜透析研究的主要课题。发病率、病因和发病机理 1.发病率各地报道不一,目前有逐年下降     

腹膜透析并发腹膜炎的原因及护理

目的为临床护士在护理腹膜透析病人时提高其生活质量，进行健康教育。方法通过日常护理资料的收集，分析14例腹膜透析患者发生腹膜炎的原因。结果发生腹膜炎的患者中糖尿病患者的比例高。和同期未发生腹膜炎患者比较，属操作不当，无菌操作不严者5人次。为了节约费用，反复使用碘伏帽者7人次。加药时违反操作2人次。结论外源性感染是发生腹膜透析相关性腹膜炎的主要原因，针对原因进行预防可减少腹膜炎的发生率。     

预防腹膜透析中腹膜炎发生的一些新进展

本文综述了近年国外在预防腹膜透析中腹膜炎发生的一些进展，指出Ｙ型和Ｏ型输液管道是目前最行之有效的方法。     

腹膜透析合并腹膜炎的治疗近况

自从腹膜透析（ＰＤ）技术进入临床以来，腹膜炎一直是ＰＤ的一个常见的合并症。不少患者因此需要住院治疗，也有的不得不拔管改做其它透析，腹膜炎甚至可以作为一个独立因素而导致患者死亡。近年来，随着腹透装置的不断改进，腹膜炎的发生率明显下降，但仍保持在０５次...     

腹膜透析并霉菌性腹膜炎6例治疗报告

我科58例腹透病人6例霉菌感染,采用改进的透析方法辅以药物治疗,治愈4例,好转1例,均未拔管。报告如下:临床资料一、一般资料及临床表现:6例中,男5例,女1例,平均年龄42岁。占透析病人的10.3%。占感染性腹膜炎的6%。BUN20～30mmol/L,SCr310～1040μmol/L,CCr8～10ml/mim,Hb40～62g/L。发热37.2～40℃,占67%。腹痛5例,剧烈腹痛1例。透出液絮状物较多,或高度混浊或呈乳白色,还有黑色团块状物。出液不畅或完全堵管。透出液检验:白细胞(180～780)×10~6/L,中性0.6～0.9。蛋白定量3.0～7.8/L。透出液6例均找到霉菌孢子,2例霉菌培养阳性:1例酵母菌,1例白色念球菌。     

腹膜清除特性在CAPD并腹膜炎改变的临床探讨

对30例CRF和ARF病人行不卧床持续性腹膜透析(CAPD)治疗,其中并腹膜炎20例次,其发生率由1983年前1次/5.87病人月降至1983年后1次/14.20病人月。并对15例腹膜炎者进行了腹膜对溶质清除特性、蛋白丢失量、葡萄糖吸收量和水的超滤量(出入超量)等方面的探讨。     

宿主防御机理与CAPD腹膜炎之间的关系

宿主防御机理与ＣＡＰＤ腹膜炎之间的关系章海涛俞雨生关键词腹膜透析腹膜炎防御机理中图法分类号Ｒ４５９．５腹膜炎是ＣＡＰＤ最常见的并发症，传统观点认为腹膜炎仅与操作过程中的污染有关，但临床上经常观察到：在相同的技术条件下，一部分患者反复发生腹膜感染，而另...     

影响腹膜透析患者发生腹膜炎的相关因素分析

目的 探讨腹膜透析(PD)患者发生腹膜炎的影响因素.方法 回顾分析2018年1月1日至2020年8月31日在郑州大学第一附属医院规律复查的PD患者的临床资料,根据是否发生腹膜透析相关性腹膜炎(PDAP)将其分为腹膜炎组和对照组,比较2组患者的临床资料,分析PD患者发生腹膜炎的影响因素,绘制受试者工作特征曲线,评估中性粒...     

原发性硬化性腹膜炎附1例报道

病例：患者，女，６３岁，有高血压病史１０余年，平时血压最高达２１０／１１０ ｍｍ Ｈｇ（１ｍｍ Ｈｇ＝０．１３３ ｋＰａ），服降压药后血压稳定；有房颤史４年余，伴甲状腺功能减退、自身免疫性溶血性贫血史１０余年，长期服用维持量甲状腺素和皮质激素。近１０天患者因头晕、恶心、胸闷、腹胀，伴胃纳减退、乏力、双下肢乏力而入院，无呕吐、腹泻、少尿等。 查体：体温３６．８℃，脉搏７６次／ｍｉｎ，呼吸１８次／ｍｉｎ，血压１６０／９５ ｍｍ Ｈｇ。神清，满月睑，巩膜无黄染，颈静脉无怒张，浅表淋巴结未及肿大。心律齐，双肺…     

腹膜透析引起的腹膜炎的诊断与治疗

腹膜透析引起的腹膜炎的诊断与治疗肖申连续不卧床性腹膜透析（ＣＡＰＤ）为终末期肾衰患者赖以维持生存的重要治疗手段，而腹膜炎是其主要而且常见的并发症，对于ＣＡＰＤ相关性腹膜炎的发病率，各个透析中心报告不一。８０年代总的发生率平均约为１．３例次／患者年。近...     

Sclerosing peritonitis

Summary An unusual case of widespread peritoneal fibrosis of unknown cause (sclerosing peritonitis) is described. The patient presented with ascites and bowel obstruction and was found to have numerous fibrous plaques involving primarily the serosa of the small bowel. The plaques were composed of bland spindle cells, ultrastructurally characterized as myofibroblasts, set within a collagenous stroma. Progressive involvement led to the patient's death 17 months after onset of symptoms. A literature review shows similar cases reported with a variety of names and a number of associated clinical conditions, none of which was present in this patient. The pathologic features seen in this case suggest that sclerosing peritonitis represents a nonspecific reaction of the peritoneal surface to a variety of insults and is characterized by florid reactive hyperplasia of submesothelial mesenchymal cells.     

Ochroconis gallopava peritonitis in a cardiac transplant patient on continuous ambulatory peritoneal dialysis

J.S.J Wong, M.I. Schousboe, S.S.L. Metcalf, Z.H. Endre, J.M. Hegarty, M.J. Maze, E.R. Keith, L.M. Seaward, R.G. Podmore. Ochroconis gallopava peritonitis in a cardiac transplant patient on continuous ambulatory peritoneal dialysis
Transpl Infect Dis 2010: 12: 455–458. All rights reserved Abstract: Ochroconis gallopava has rarely been isolated in immunosuppressed patients. We report the first case to our knowledge of O. gallopava peritonitis in a cardiac transplant patient on continuous ambulatory peritoneal dialysis. A 58‐year‐old man who had undergone cardiac transplant 8 years earlier alerted his dialysis nurses to the presence of black material in his catheter lumen. Fungal hyphae were seen on direct microscopy of the black material and from the dialysate effluent, and O. gallopava was cultured from both after 1 day. He was treated successfully with a single dose of intravenous voriconazole, followed by 2 weeks of oral voriconazole.     

Fungal peritonitis among the peritoneal dialysis patients of four Turkish centres

This study evaluates the clinical findings and treatment of continuous ambulatory peritoneal dialysis (CAPD) patients with fungal peritonitis in Istanbul from 2000 to 2010. The clinical records of 15 patients with fungal peritonitis among the total 795 patients were reviewed for the clinical and laboratory data. The mean duration of dialysis from the initiation of treatment until the development of fungal peritonitis was 41.14 months. Fungal peritonitis was the primary episode of infection in eight patients. In five other patients previous intensive antibiotherapy was documented. The isolated mircoboes were Candida albicans in six, non-C. albicans in eight and Aspergillus fumigatus in one patient. Tenckoff catheters were removed in all cases and antifungal treatment was given for a minimum of three weeks. Two patients died in the hospital due to the fungal infection whereas others were transferred to haemodialysis. This study highlights the importance of removing the catheter and initiating antifungal therapy as soon as possible in cases of fungal peritonitis because it is responsible for high morbidity and mortality.     

Sclerosing encapsulating peritonitis in two patients with liver cirrhosis

Sclerosing encapsulating peritonitis (SEP) has been reported in a wide variety of patients, including those who have undergone peritoneal dialysis (PD), young adolescent girls, cirrhotic patients after peritoneal-venous shunting (PVS), and patients treated with -blockers. Nevertheless, the etiology of SEP remains obscure. In this article, we report on two patients with severe liver cirrhosis who were diagnosed as having SEP. The association of SEP with liver cirrhosis in patients who have not undergone PVS has previously been reported only rarely. Neither of our two patients had received PD or PVS, and neither had been treated with -blockers, but both had suffered persistent intraabdominal infection. In one patient, we performed therapy combining total enterolysis with the oral administration of prednisolone, at 5mg/day. The patient recovered and is currently free of symptoms at approximately 15 months after surgery. We believe that SEP may produce complications in cirrhotic patients with persistent intraabdominal infection, and that a combination therapy of surgical and immunosuppressive treatment may be effective for alleviating the small-intestinal obstruction due to SEP.     

Accurate definition and management of idiopathic sclerosing encapsulating peritonitis

AIM: To review the literature on idiopathic sclerosing encapsulating peritonitis(SEP), also known as abdominal cocoon syndrome. METHODS: The Pub Med, MEDLINE, Google Scholar, and Google databases were searched using specific key words to identify articles related to idiopathic SEP. These key words were "sclerosing encapsulating peritonitis," "idiopathic sclerosing encapsulating peritonitis," "abdominal cocoon," and "abdominal cocoon syndrome." The search included letters tothe editor, case reports, review articles, original articles, and meeting presentations published in the English-language literature from January 2000 to May 2014. Articles or abstracts containing adequate information about age, sex, symptom duration, initial diagnosis, radiological tools, and surgical approaches were included in the study. Papers with missing or inadequate data were excluded. RESULTS: The literature search yielded 73 articles on idiopathic(primary) SEP published in 23 countries. The four countries that published the greatest number of articles were India(n = 21), Turkey(n = 14), China(n = 8) and Nigeria(n = 3). The four countries that reported the greatest number of cases were China(n = 104; 53.88%), India(n = 35; 18.13%), Turkey(n = 17; 8.80%) and Nigeria(n = 5; 2.59%). The present study included 193 patients. Data on age could be obtained for 184 patients(range: 7-87 years; mean ± SD, 34.7 ± 19.2 years), but were unavailable for nine patients. Of the 184 patients, 122 were male and 62 were female; sex data could not be accessed in the remaining nine patients. Of the 149 patients whose preoperative diagnosis information could be obtained, 65(43.6%) underwent operations for abdominal cocoon, while the majority of the remaining patients underwent operations for a presumed diagnosis of intestinal obstruction and/or abdominal mass. Management information could be retrieved for 115 patients. Of these, 68 underwent excision + adhesiolysis(one laparoscopic); 24 underwent prophylactic appendectomy in addition to excision + adhesiolysis. Twenty patients underwent various resection and repair techniques along with excision + adhesiolysis. The remaining three patients were managed with antituberculosis therapy(n = 2) and immunosuppressive therapy(n = 1). CONCLUSION: Idiopathic SEP is a rare disorder characterized by frequently recurring bouts of intestinal obstruction. Surgical therapy is the gold standardmanagement strategy.     

Autoantibodies in primary sclerosing cholangitis

The aetiology of primary sclerosing cholangitis （PSC） is not known and controversy exists as to whether PSC should be denominated an autoimmune disease. A large number of autoantibodies have been detected in PSC patients, but the specificity of these antibodies is generally low, and the frequencies vary largely between different studies. The presence of autoantibodies in PSC may be the result of a nonspecific dysregulation of the immune system, but the literature in PSC points to the possible presence of specific antibody targets in the biliary epithelium and in neutrophil granulocytes. The present review aims to give an overview of the studies of autoantibodies in PSC, with a particular emphasis on the prevalence, clinical relevance and possible pathogenetic importance of each individual marker.     

Evolving concepts in primary sclerosing cholangitis

Patients suffering from primary sclerosing cholangitis (PSC) show considerable differences regarding clinical manifestations (i.e. large duct versus small-duct PSC, presence or absence of concomitant inflammatory bowel disease), disease progression, risk for malignancy and response to therapy, raising the question whether PSC may represent a mixed bag of diseases of different aetiologies. The growing list of secondary causes and diseases 'mimicking' or even overlapping with PSC (e.g. IgG4-associated sclerosing cholangitis), which frequently causes problems in clear-cut discrimination from classic PSC and the emerging knowledge about potential disease modifier genes (e.g. variants of CFTR, TGR5 and MDR3) support such a conceptual view. In addition, PSC in children differs significantly from PSC in adults in several aspects resulting in distinct therapeutic concepts. From a clinical perspective, appropriate categorization and careful differential diagnosis are essential for the management of concerned patients. Therefore, the aim of the current review is to summarize current and evolving pathophysiological concepts and to provide up-to-date perspectives including future treatment strategies for PSC.     

肝炎肝硬化并发自发性细菌性腹膜炎治疗探讨

目的探讨肝炎肝硬化并发自发性细菌性腹膜炎的治疗。方法147例肝炎肝硬化并发自发性细菌性腹膜炎患者行综合治疗:1积极支持治疗;2舒普深抗感染,每日4克,共3周;3每次放腹水后使用罗氏芬1克,腹腔注射。同期另118例肝炎肝硬化并发自发性细菌性腹膜炎患者,接受积极支持治疗和舒普深抗感染,每日4克,共2周。结果与对照组比,抗感染3周疗程加放腹水组患者腹水消退快,总胆红素下降明显,腹腔感染控制较彻底,一年后自发性细菌性腹膜炎复发率显著降低(P<0.05)。结论肝炎肝硬化并发自发性细菌性腹膜炎的抗感染治疗疗程要长,适时放腹水可提高疗效。     

Idiopathic sclerosing encapsulating peritonitis （or abdominal cocoon）： A report of 5 cases

Sclerosing encapsulating peritonitis （SEP） is a rare cause of intestinal obstruction that is characterized by a thick grayish-white fibrotic membrane encasing the small bowel. SEP can be classified as idiopathic, also known as abdominal cocoon, or secondary. It is difficult to make a definite pre-operative diagnosis. We experienced five cases of abdominal cocoon, and the case files were reviewed retrospectively for the clinical presentation, operative findings and outcome. All the patients presented with acute, subacute and chronic intestinal obstruction. Computed tomography （CT） showed characteristic findings of small bowel loops congregated to the center of the abdomen encased by a soft-tissue density mantle in four cases. Four cases had an uneventful post-operative period, one case received second adhesiolysis due to persistent ileus. The imaging techniques may facilitate pre-operative diagnosis. Surgery is important in the management of SEP.