Clinical Experience with the Peritoneovenous Shunt for Intractable Ascites

本研究是分析探討腹腔靜脈分流術（LeVeen 或 Denver shunt），在治療肝硬化頑固性腹水的效果，併發症及預後。本院自1993年7月到1998年1月期間，共有19位肝硬化病人合併頑固性腹水，接受腹腔靜脈分流術。男：女＝8:11，平均年齡58.2歲，（43-76 歲）。Child-Pugh B有9位， Child-Pugh C有10位。病人在術中皆能至少移除 3000c.c.的腹水，且使用預防性抗生素，包括Cefazoli及Gentamicin，結果：腹腔靜脈分流術的功能，能維持4天到210天，平均76.8天。術後併發症：自發性細菌性腹膜炎有9位；食道靜脈曲張出血有8位；分流管感染有6位；肋膜積水有4位；肺炎、中心靜脈插管感染、分流管子阻塞以及肝性腦病變各有3位；腹水漏出及傷口感染各有1位；早期術後死亡及再入院原因，大都是感染，主要菌種是金黃色葡萄球菌(S.aureus)及大腸桿菌(E.coli)。術後腹水有改善和尿量有意義的增加，但一個月存活率78.9%(15/19)，六個月存活率31.6%(6/19)，l年存活率5.3%(l/l9)。結論：腹腔靜脈分流術，對於嚴重肝硬化合併頑固性腹水病人，術後僅有改善腹水及增加尿量之益處，術後併發症不少，亦無法改善存活率。

關鍵字

腹腔靜脈分流術；失代償性肝硬化；頑固性腹水

並列摘要

We retrospectively reviewed the medical records of 19 patients with decompensated liver cirrhosis and intractable ascites who underwent placement of a peritoneovenous shunt from July l993 through January 1998, at Chang Gung Memorial Hospital, Linkou Taiwan. There were eight men and 11 women, with a mean age of 58.2 years (range, 43 to 76 years). Nine patients had Child-Pugh B and 10 had Child-Pugh C stage liver disease. The duration of shunt patency ranged from 4 to 210 days, with an average of 76.8 days． These 19 patients experienced a total of 41 postoperative comlications; the events included spontaneous bacterial peritonitis (9 cases), esophageal variceal bleeding (8), shunt infection (6), pleural effusion (4), pneumonia (3), central venous pressure (CVP) catheter infection (3), shunt occlusion (3), hepatic encepalopathy (3), wound infection (1), and ascites leakage (1). Escherichia coli and Staphylococcus aureus were responsible for most cases of infection. The survival rates were 78.9% (15/19) at 1 month, 31.6% (6/19) at 6 months, and 5.3% (1/19) at 1 year. In conclusion, the peritoneovenous shunt was effective in relieving intractable ascites and increasing urine output．However, shunt complications were common and the survival rate did not improved．Physicians should be very careful in selecting patients to receive peritoneovenous shunts.

並列關鍵字

peritoneovenous shunt ； decompensated liver cirrhosis ； intractable ascites

國際替代計量

Clinical Experience with the Peritoneovenous Shunt for Intractable Ascites

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