维持性腹膜透析并发结肠瘘、膀胱瘘1例并文献复习

doi:10.3969/j.issn.1004-583X.2024.11.009

摘要/Abstract

摘要：

目的探讨维持性腹膜透析并发结肠穿孔、膀胱穿孔的临床特征及治疗方法。方法回顾性分析维持性腹膜透析并发结肠穿孔、膀胱穿孔1例临床资料及诊治经过,并进行文献复习。结果患者老年男性,主因“发现血肌酐升高9年,维持性腹膜透析1年,导管功能不良5天”入院。既往2022年2月确诊为直肠癌,行直肠癌根治术、放疗,后停止腹膜透析,改为规律血液透析,2022年9月出现腹膜透析导管功能不良,考虑并发肠穿孔。诊断为结肠瘘、膀胱瘘,给予抗感染治疗后病情有所好转,因直肠癌转移于院外死亡。结论对于合并肠道肿瘤、腹部手术史及放疗史的腹膜透析患者应术前拔除腹膜透析管,改为血液透析。当维持性腹膜透析患者出现腹痛、导管引流障碍、灌入腹膜透析液后出现大量水样腹泻等症状时,应警惕肠穿孔发生,一旦确诊,尽早拔管及时改为血液透析。

关键词: 腹膜透析, 肠穿孔, 膀胱穿孔

Abstract:

Objective To explore the clinical features and treatment of maintenance peritoneal dialysis (MPD) complicated with colon perforation and bladder perforation. Methods The clinical data, diagnosis and treatment of colon perforation and bladder perforation in one MPD patient were retrospectively analyzed, and the literature was reviewed. Results An elderly male presented due to “elevated serum creatinine for 9 years, maintenance peritoneal dialysis for 1 year, and poor catheter function for 5 days”. He was diagnosed with rectal cancer in February 2022 and underwent radical rectal cancer surgery and radiotherapy. After dialysis, peritoneal dialysis (PD) was stopped and changed to regular hemodialysis. In September 2022, he had poor peritoneal dialysis catheter function, and intestinal perforation was considered. He was diagnosed as colon fistula and bladder fistula. His condition was improved after anti-infection treatment, but died of rectal cancer metastasis after discharge. Conclusion For PD patients with intestinal tumor, history of abdominal surgery and radiotherapy, the laparodialysis tube should be removed before operation and hemodialysis should be replaced. When MPD patients have symptoms like abdominal pain, obstruction of catheter drainage, and massive watery diarrhea after infusion of abdominal permeate solution, the occurrence of intestinal perforation should be concerned. Once diagnosed, extubation should be changed to hemodialysis as soon as possible.

Key words: peritoneal dialysis, intestine perforation, bladder perforation

中图分类号:

R459.5

徐若云, 刘琼, 贾敏楠, 刘冰. 维持性腹膜透析并发结肠瘘、膀胱瘘1例并文献复习[J]. 临床荟萃, 2024, 39(11): 1016-1020.

Xu Ruoyun, Liu Qiong, Jia Minnan, Liu Bing. Maintenance peritoneal dialysis complicated with colon fistula and bladder fistula: A case report and literature review[J]. Clinical Focus, 2024, 39(11): 1016-1020.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.11.009

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I11/1016

图/表 3

图1 患者腹盆部CT结果 a.2022年8月23日腹盆部CT示PD管位置良好;b.2022年9月19日腹盆部CT示PD管端口进入结肠;c.2022年10月8日腹盆部CT示管末端与膀胱相通

Fig.1 Abdominal and pelvic CT findings a. Abdominal and pelvic CT on August 23, 2022 showed that the PD catheter was in a good position. b. Abdominal and pelvic CT on September 19, 2022 showed that the tip of the PD catheter entered the colon; c. Abdominal pelvic CT on October 8, 2022 showed that the end of the peritoneal dialysis catheter was communicated with the bladder

图2 患者窦道及瘘管造影结果 a.2022年9月21日窦道及瘘管造影示经PD管注入适量碘造影剂后可见造影剂进入邻近小肠内,盆腔内未见明显造影剂弥散、涂布;b.2022年10月8日窦道及瘘管造影示经PD管注入适量碘造影剂后可见造影剂在盆腔内弥散、涂布,未见肠管显影

Fig.2 Radiography of the sinus and fistula a. Radiography of the sinus and fistula on September 21, 2022 showed that the contrast agent in the adjacent small intestine after injecting an appropriate amount of iodine contrast agent through the peritoneal dialysis catheter, without obvious diffusion or spreading of contrast agent in the pelvic cavity. b. Radiography of the sinus and fistula on October 8, 2022 showed that after injecting an appropriate amount of iodine contrast agent through the peritoneal dialysis catheter, the contrast agent was diffused and coated in the pelvic cavity, without the imaging of the intestinal tube

图3 患者SPECT/CT结果 a.2022年9月20日ECT示显像剂经PD管进入肠腔;b.2022年10月11日ECT示显像剂经PD管全部进入膀胱

Fig.3 SPECT/CT findings a. ECT on September 20, 2022 showed that the imaging agent entered the intestinal lumen through the PD catheter; b. ECT on October 11, 2022 showed that all the imaging agent entered the bladder through the PD catheter

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