关键词: 腹膜透析； 外科手术； 硬化性腹膜炎； 腹膜透析相关性腹膜炎

Abstract: Objective To evaluate the surgical treatments of refractory sclerosing peritonitis related peritoneal dialysis.Methods Clinical data of 15 patients with refractory sclerosing peritonitis related to peritoneal dialysis treated in the General Surgery Department of the 900th Hospital of the Joint Logistics Support Force of the People's Liberation Army from June 30,2014 to May 30,2018.Among them,5 cases underwent “open abdomen peritoneal catheter removal + intestinal adhesiolysis + abdominal infection flushing and drainage with catheter”,4 cases underwent “laparoscopic peritoneal catheter removal + intestinal adhesiolysis + abdominal infection flushing and drainage with catheter”,3 cases underwent “laparoscopic peritoneal dialysis catheter removal + abdominal infection flushing and drainage with catheter”,2 cases underwent “open abdomen peritoneal dialysis catheter removal + abdominal infection flushing and drainage with catheter”,and 1 case underwent “laparoscopic examination combined with laparotomy exploration and removal of lower abdominal catheter + intestinal adhesiolysis + abdominal infection flushing and drainage with catheter”.Age, gender, clinical symptoms, abdominal CT examination, peripheral blood routine, blood biochemistry, blood C- reactive protein (CRP), white blood cells, biochemistry, and aetiology of peritoneal dialysis fluid were collected and followed up, and the therapeutic effect was evaluated.Results 15 patients were transferred to the Department of Surgery after ineffective treatment in the Department of Internal Medicine.Preoperatively(after 5 days of antibiotic treatment) compared to before antibiotic treatment,there were no significant changes in blood WBC,blood NEUT%,CRP,and peritoneal fluid WBC(P>0.05).Laparoscopic exploration or laparotomy exploration was performed,during which the peritoneal dialysis catheter was removed and the abdominal infection focus was cleared.A pelvic cavity washout drainage tube was left in place postoperatively.Fourteen patients had a good recovery after surgery,with effective control of peritonitis symptoms and no complications such as intestinal obstruction or enterocutaneous fistula.After the removal of the peritoneal dialysis catheter,all patients switched to hemodialysis.A comparison of inflammatory markers before and after surgery showed a significant decrease after surgery.Three days postoperatively compared to before surgery(after 5 days of antibiotic treatment),there were no significant changes in blood WBC,blood NEUT%,CRP,and peritoneal fluid WBC(P>0.05).Seven days postoperatively compared to before surgery(after 5 days of antibiotic treatment),there was a significant decrease in blood WBC[（7.43±2.65）×10⁹/L VS（10.17±5.24)×10⁹/L],blood NEUT%[(88.23±9.02）% VS（85.07±11.57)%],and CRP[(152.88±113.01）mg/L VS（114.49±92.97)mg/L](P<0.05);the peritoneal fluid WBC at 7 days postoperatively showed no significant change compared to before surgery(after 5 days of antibiotic treatment)(P>0.05).The cases were followed up for at least 22 months,and 13 patients did not experience peritonitis or intestinal obstruction again.One patient died 39 days after surgery due to multiple organ failure,and one patient died from other causes after a 2-year follow-up.Conclusion For refractory sclerosing peritonitis related peritoneal dialysis that is ineffective in medical conservative treatment,On the basis of reasonable and effective antibiotics to control infection,surgical intervention should be actively carried out and surgical methods such as surgery should be used to control the progress of peritonitis,reduce mortality and improve the cure rate.

Key words: peritoneal dialysis; surgical procedures; sclerosing peritonitis; peritoneal dialysis-associated peritonitis