腹膜透析カテーテル位置異常に対し腹腔鏡下に整復およびperitoneal wall anchor techniqueで腹壁固定を行った1例

Laparoscopic taxis and fixation using a peritoneal wall anchor technique in a patient with a migrated peritoneal dialysis catheter

◆要旨：腹膜透析カテーテルの位置異常は腹膜透析の重要な合併症の1つで，時として注・排液不良の原因となり，カテーテルの抜去や血液透析への移行も余儀なくされることがある．患者は77歳，女性で糖尿病性腎症のため腹膜透析が導入されていた．今回カテーテル位置異常に対し，腹腔鏡的にカテーテル位置を整復し，peritoneal wall anchor technique（以下，PWAT）を用いてカテーテルの腹壁固定を行った．腹腔鏡での観察により原因を同定し，確実に整復することが可能で，なおかつPWATを用いることで，簡便かつ安全にカテーテルの固定を行うことができた．腹腔鏡下での整復ならびに固定は，非観血的処置が無効なカテーテル位置異常に対してまず試みるべき術式であると考えられた．

　Migration of the catheter tip is an important complication of peritoneal dialysis, and can lead to difficulties with infusion and drainage. If it is impossible to remedy the migration by a nonsurgical method, continuation of peritoneal dialysis becomes impossible, and it may be necessary to remove the catheter and to commence hemodialysis. We report the case of a 77-year-old woman who was treated with peritoneal dialysis due to diabetic nephropathy. After migration of the catheter tip, we performed laparoscopic taxis and fixation of the catheter using a peritoneal wall anchor technique. This method appears to be easier and safer than methods reported previously, and it should be the first choice of treatment for patients with migration of the catheter tip that cannot be corrected by nonsurgical means.