利用Guide Wire來矯正位移之腹膜透析導管

Correction of Migrated Peritoneal Dialysis Catheters by a Guide Wire

在腹膜透析患者中，透析導管的位移以及功能不全是一件經常可遭遇上的缺點。為了避免再一次的外科手術，利用放射線的螢光透視鏡合併guide wire的經皮操作方式來解決問題是另一種可行的選擇。不過，位移且功能不彰的透析導管本身有許多不同的起因。所以使用guide wire經皮操作來修正位移導管的結果，也各有不同。在過去幾年中，我們在螢光透視鏡下使用lunderquist guide wire（Nycomed, NY），對11位有導管位移的患者進行經皮guide wire操作術。結果發現，其中有5位單純性導管位移的患者，100﹪全部均可被此方法矯正回來，不過其餘的6位患者，包括了3位導管位移合併粘連，2位原先導管的角度不良，以及1位腹膜外導管的患者等，均無法使用經皮guide wire操作術來矯正。在這所有11位的個案中，未有併發症產生。雖然，利用此方法並無法克服所有不同起因的導管位移，但使用此方法對單純性位移的腹膜透析導管來進行矯正，其結果還是不錯的。所以我們建議：在腹膜透析導管位移的患者準備接受再次手術矯正前，至少可以考慮嘗試一次既安全又簡單的guide wire 矯正操作處置。

Malpositioning and malfunction of the peritoneal dialysis catheter is a frequently encountered drawback during continuous ambulatory peritoneal dialysis (CAPD). To avoid surgical revision, percutaneous manipulation of malpositioned catheters under fluoroscopic guidance is an option. However, malfunction and malpositioning result from a variety of catheter difficulties. Thus, in various catheter difficulties, the effect of percutaneous manipulation may differ. In the past year, a Lunderquist guide wire (Nycomed, NY) has been employed to correct the malpositioning and malfunction of peritoneal dialysis catheter in 11 CAPD patients. The empirical results revealed that all 5 (100%) instances of simple migration were corrected successfully with this procedure. However, in the other remaining six cases, which included catheter adhesion (three cases), extraperitoneal catheter implantation (one case) or inadequate initial implantation angle (two cases), the procedure failed. Notably, no complications were noted following this manipulation. Thus, the Lunderquist guide wire is one of an appropriate device for percutaneous manipulation of peritoneal dialysis catheter malfunction. However, the effect of percutaneous manipulation on peritoneal catheter malfunction is may not be able to control many types of catheter difficulties. Based on our limited experience and previous literature reports, this procedure only is appropriate for simple migration, blood clotting, and painful drainage. We therefore suggest that patients who will receive surgical revision for a migrated peritoneal dialysis catheter should have at least one attempt at correction using this safe and easy procedure before surgery.