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| 지속성 외래복막투석환자에서 조기 및 후기 복강 관류액 누출 |
| 방종효 , 김준홍 , 조성 , 권태환 , 김용림 , 조동규 |
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| Abstract |
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Continuous ambulatory peritoneal dialysis(CAPD) is now a well-established mode of therapy for end- stage rena@l disease. Dialysate leaks as well as other technical complications, however, still remain as an important complication of CAPD. The dialysate leaks may develop early after catheter implantation(early leaks), or months or even years later(late leaks). In either case, the leak may stop if peritoneal dialysis is discontinued for a period ranging from two days to three weeks. From January 1988 through August 1994, 201 CAPD patients were analyzed retrospec- tively. Twenty six patients developed early leaks (within 30 days of catheter insertion) and 9 patients late leaks(beyond 30 days of catheter insertion). The incidences of early and late leaks were 12.9% and 4.5% respectively. Most early leaks were manifested externally through the exit site, but late leaks usually by poor dialysate outflow, localized edema and/or subucutaneous fluid collection. Concurrent complications of the early and late leaks were mainly CAPD peritonitis and exit site infection. The catheter removal rates of early and late leaks were 3.8% and 33.3% respectively. Early leaks were su- ccessfully managed by 2 weeks' discontinuation of CAPD alone in most cases. In late leaks, our experience does suggest that catheter removal will be required if leakage continues beyond 96 hours. Early leaks differ from late leaks in some clinical manifestations and are successfully managed by temporary discontinuation of CAPD. Late leaks are an uncommon and unpredictable complication of CAPD and resulted frequently in replacement of peritoneal catheters. Excessive exercise or mechani- cal manipulation of catheter might result in the occurrence of late leaks. |
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