계속적 외래복막투석에서 도관기능부전시 도관제거에 앞서 도관기능 회복을 위한 처치 = Catheter Salvage Procedures for thc Patients with CAPD Catheter Malfunction

다국어 초록 (Multilingual Abstract)

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다국어 초록 (Multilingual Abstract)

Objectives: The peritonitis and peritoneal catheter malfunction remained as two major causes for the failure of chronic peritoneal dialysis. Extensive quantitative data on the nonoperative technique alternative to surgical placement of a new catheter in catheter malfunction due to dislodgment and obstruction are not available. Methods: From January 1991 through February 1993, thirteen fluoroscopy guided brushings and twelve laparoscopy guided manipulations were performed for 15 adult patients with catheter malfunction due to dislodgment and obstruction in an effort to prolong catheter life. Results : 1) The causes of catheter malfunction were four omental wrapping with secondary migration, four obstruction by fibrin deposits or blood clots, and seven dislodgment and obstruction. 2) With fluoroscopy guided brushing and/or laparoscopy manipulation, catheter malfunction were restored in 11 patients(73%). Among 11 patients, catheter malfunction were restored in 4 patients with fluoroscopy guided brushing, 4 patients with laparoscopic manipulation, and 3 patients with combination of two procedures. However, the remaining four patients, even after repeated manipulations, ended with catheters removal due to persistent malfunction. Eight patients had immediately successful restoration of catheter malfunction at the time of the procedure, two patients in the first week, and one patient in the third week. 3) There were four complications followed by the procedure : two were CAPD peritonitis and exit site infection and leakage followed by fluoroscopy guided brushing, and the other were laparoscopy related leakage from puncture site which was recovered by resting for two weeks and a broken catheter tip within peritoneal cavity which could be removed safely by laparoscopy. Conclusion: Fluoroscopy or laparoscopy guided manipulation of catheter was considered as re- commendable techniques in the catheter malfunction and could also be a desirable alternative to surgical placement of a new catheter.