Peritoneal Dialysis-associated Peritonitis With Delayed Removal Of The Peritoneal Catheter:Clinical Manifestation,Etiology,Imaging Characteristics And Treatment

【Objectives】 1.To analyze the clinical manifestation,etiology and imaging features of peritoneal dialysis-associated peritonitis(PDAP)with delayed removal of the peritoneal catheter and provide the evidences for the diagnosis and treatment of such patitents.2.To explore the treatment effect of the new comprehensive treatment technology,and to search for the clinical manifestation,etiology and imaging features are helpful for the decision of clinical treatment plan,and to provide reference basis for the treatment of such patients.【Methods】 1.The clinicopathological data of 50 cases of PDAP with delayed removal of the peritoneal catheter in our hospital from January 1,2012 to August 31,2018 are collected and classified as delayed extubation group(group D).Meanwhile,27 patients with normal maintenance PD during the same period were selected and classified as negative control group(group A).37 patients with non-refractory PDAP were classified as positive control group 1(group B).Refractory PDAP conservative treatment was effective in 15 cases,which were classified as positive control group 2(group C).A case-control study was conducted to investigate the clinical manifestation,etiology and imaging features of delayed extubation of PDAP.2.According to whether to use the new comprehensive treatment technology,we divided the patients into two groups,A and B.Inclusion criteria for group A(new technology group,n=27):(1)Using the peritoneal cavity double cannula underpressure continuous irrigation and drainage,laparoscopic or exploratory laparotomy;(2)The PDAP patients with delayed extubation admitted from March 31,2015 to August 31,2018;(3)Satisfy one of them.Inclusion criteria of group B(old technology group,n=23):(1)Not Using the peritoneal cavity double cannula underpressure continuous irrigation and drainage,laparoscopic or exploratory laparotomy;(2)Patients with delayed extubation admitted from January 1,2012 to March 30,2015;(3)Simple extubation + anti-infection treatment;(4)At the same time to meet the all three.The retrospective case-control study was conducted to explore the efficacy of the new comprehensive treatment technology.To analyze the correlation between imaging and intraoperative findings.【Results】 1.Compared with non-refractory PDAP,the PDAP group with delayed extu bation had longer hospitalization time,higher hospitalization costs,more obvious peritonitis signs and more severe clinical manifestations,poorer nutrition status,h igher coagulation,more severe infection,more complicated etiology,and more co mmon secondary hyperparathyroidism and incomplete intestinal obstruction.2.Elderly patients,secondary hyperparathyroidism,and incomplete intestinal ob struction were more common and etiologies are more complicated in the PDAP group with delayed extubation than in the refractory PDAP group with effectiv e conservative medical treatment.There was no significant difference between th e two groups in the clinical manifestations,signs,inflammatory indicators,malnutrit ion,hypercoagulation.However,the PDAP group with delayed extubation had lowe r serum potassium levels.3.Delayed extubation of PDAP was associated with 8 cases(27.6%)of ile us and 6 cases(20.7%)of peritoneal thickening.Eight cases of early EPS were found by imaging examination,and 13 cases were confirmed by laparoscopy or l aparotomy(P=0.08).4.The pathogens in the delayed extubation of PDAP were mainly fungi,do uble infection and mixed infection,accounting for 56.4%,which was significantl y higher than that of non-refractory PDAP and refractory PDAP(P<0.01).5.There was no significant difference in demographics,primary morbidity,complications,peritonitis signs and related laboratory indicators between the com prehensive treatment new technology group and old technology group,but the 60-day and 90-day survival rates were significantly improved in the comprehensiv e treatment new technology group,respectively,which were 100% vs 78.3%(P=0.02),96.3% vs 73.9%(P=0.04).6.The morbidity of EPS in the comprehensive treatment group was as high as 48.1%,but the mortality was only 7.69%.【Conclusion】 1.PDAP patients with delayed extubation have clinical characteristics of ad vanced age,long hospitalization time,high hospitalization cost,secondary hyperparat hyroidism,severe infection,high coagulation,malnutrition,and about 20% of intesti nal obstruction.2.The characteristics of PDAP bacterial spectrum of delayed extubation wer e complicated pathogen infection,mainly fungus,double infection and mixed infe ction.3.The survival rate of the patients in the new comprehensive treatment gro up was significantly improved.4.Laparoscopy and postoperative the peritoneal cavity double cannula under pressure continuous irrigation and drainage are the key technologies for treatmen t of delayed extubation of PDAP.For dialysis age longer,imaging showed EPS p erformance,etiology is complicated,are the indications of laparoscopy or laparoto my.For laparoscopic surgery in abdominal cavity infection serious can be change d to laparotomy,according to the situation of intraoperative intraperitoneal adhes ion and empyema,decide whether to place irrigation and drainage tube.