1、Complications of peritoneal dialysis: evaluation with CT peritoneography.,北大醫(yī)院腹組早讀片 2011.03.09,NTRODUCTION,Continuous ambulatory peritoneal dialysis (持續(xù)性非臥床腹膜透析CAPD) is used to treat endstage renal failure in an increasing number of patients. CAPD has an advantage over hemodialysis in that it allows

2、 patients greater freedom to perform daily activities; it also provides other clinical benefits. However, the long-term effectiveness of CAPD is limited by complications, which have various causes.,INDICATIONS AND TECHNIQUE,適應(yīng)癥:復(fù)發(fā)性腹膜炎，透析液交換困難，腹壁或生殖器軟組織水腫，腹壁局限性膨出，超濾減少 方法：在CT腹膜造影前，腹腔的透析液要完全引流；1ml/kg非離

3、子型造影劑+ 30ml/kg透析液混勻，緩慢輸入腹腔，要求嚴(yán)格無(wú)菌操作；患者行走、翻身等活動(dòng)30分鐘后CT掃描；檢查完畢將含有造影劑的腹透液置換出來(lái),NORMAL FINDINGS,Limited dispersion due to adhesions,ABNORMAL FINDINGS,Peritonitis: Bacterial peritonitis is the most common complication of CAPD. Patients undergoing CAPD are more susceptible to tuberculous peritonitis than t

4、hose with normal renal function or those undergoing hemodialysis, partly because of their decreased cellular immunity.,Infected fluid collections.,Tuberculous peritonitis,Catheter-related Complications,Catheter Malposition.The distal catheter tip should be inserted in a dependent position into the r

5、ectovesical pouch (in male patients) or the rectouterine pouch (in female patients). Catheter Kinking. Catheter Entrapment.,Catheter Malposition,Catheter Kinking,Catheter entrapment,Dialysate Leakage and Hernias,Sudden increases in pressure may lead to the development of hernias and leaks. Dialysate

6、 leaks may result in poor drainage of dialysate and significant fluid retention. The most common sites of hernias that occur as complications of CAPD are at the umbilicus, near the peritoneal incision for catheter insertion, and in the inguinal canal.,Sclerosing Encapsulating Peritonitis,Hepatic Sub

7、capsular Steatosis,References,1 Wang, Q, Ni, ZH, Zhu, ML, et al. Diagnostic value of CT peritoneography for non-infectious complications of peritoneal dialysisJ. Zhong Xi Yi Jie He Xue Bao. 2008, 6(5): 478-81. 2 Prokesch, RW, Schima, W, Schober, E, et al. Complications of continuous ambulatory peritoneal dialysis: findings on MR peritoneographyJ. AJR Am J Roentgenol. 2000, 174(4): 987-91. 3 Cochran, ST, Do, HM, Ronaghi, A, et al. Complications of peritoneal dialysis: evaluation with CT peritoneographyJ. Radiographics. 1997, 17(4):