腹膜透析相关性腹膜炎后包裹性腹膜硬化症1例

包裹性腹膜硬化症(encapsulating peritoneal sclerosis，EPS)是腹膜透析患者罕见但严重的并发症，50%患者在确诊后12 个月内死亡，早期无明显临床症状，易漏诊，少有早期诊断的报道。2018 年12 月22 日中南大学湘雅三医院肾脏风湿免疫科收治1 例因腹膜炎后继发EPS的患者，透析时间达17 个月。该患者在腹膜炎后出现腹膜透析管机械障碍，腹膜透析液出入腹腔困难，遂行腹腔镜检查，术中证实腹膜略有增厚，回盲段肠管与壁层腹膜紧密粘连包裹，诊断为EPS并行粘连松解术，术后腹膜透析管恢复正常。继续对患者进行控制感染、营养支持、血液透析过渡等综合治疗，10 d 后患者的腹膜炎得到了控制，因而恢复腹膜透析。出院后继续口服莫西沙星抗感染2 周，随访6 个月，现维持自动腹膜透析，患者透析顺利、病情稳定。临床医师需提高对EPS的认识，早期诊断及腹腔镜下松解粘连有助于继续腹膜透析治疗。

A case of encapsulated peritoneal sclerosis after peritoneal dialysis-related peritonitis

Encapsulating peritoneal sclerosis (EPS) is a rare but severe complication of peritonealdialysis. A total of 50% of the patients died within 12 months after being diagnosed. Thereare no obvious clinical symptoms in the early stage of EPS, which is easy to be missed.And there are few case reports of EPS in early stage. On December 22, 2018, a 70-year-oldmale patient undergoing peritoneal dialysis for 17 months, who was diagnosed as EPS, wasadmitted to the Department of Nephrology, the Third Xiangya Hospital, Central South University. The patient’s peritoneal dialysis catheter was obstructed after peritonitis. Theperitoneal dialysis fluid couldn’t be drain in and out of the abdominal cavity. Therefore, thelaparoscopy was performed to repair the catheter. The operation in progress showed that theperitoneum was slightly thickened and the ileocecal intestinal tube was closely adhered tothe parietal peritoneum where the catheter was wrapped, indicating the early stage of EPS.Peritoneal relaxation was performed. The patient’s catheter was normal after adhesiolysis.He underwent hemodialysis, nutritional supporting as well as peritoneal dialysis transition,etc. The peritonitis was controlled after 10 days and the peritoneal dialysis was resumed.After discharge from hospital, the patient took moxifloxacin for 2 more weeks. Wefollowed up the patient for 6 months. The automated peritoneal dialysis is maintained, andeverything remains normal. Clinicians need to improve understanding of EPS. Earlydiagnosis and laparoscopic adhesiolysis is helpful to continue peritoneal dialysis treatment.