Palliative Treatment of Malignant Refractory Ascites by Positioning of Denver Peritoneovenous Shunt
Palliative Treatment of Malignant Refractory Ascites by Positioning of Denver Peritoneovenous Shunt
复制标题
丹佛腹腔静脉分流术定位姑息治疗恶性难治性腹水
作者：
C. Zanon;M. Grosso;F. Aprà;R. Clara;M. Bortolini;F. Quaglino;S. Cornaglia;P. Simone
恶性腹水在某些类型的终末期癌症患者中相对常见。基于限制液体和盐分的传统治疗和利尿治疗往往无法遏制肿瘤性腹水。这些患者因此反复接受腹部穿刺术，导致进一步的血浆蛋白丢失和腹部脏器损伤的风险。这项研究的目的是评估丹佛腹膜静脉分流术的经验和恶性腹水患者的预后，并提出一些改进措施以提高设备的通畅性。自1997年2月至1999年12月，共对42例患者进行了44次丹佛腹膜静脉分流术，其中女性17例，男性25例，年龄38~77岁，平均62.3岁。入院时，72%的患者有疼痛，88%的患者吞咽困难，66%的患者恶心和/或呕吐，83%的患者呼吸困难。11例采用利多卡因局部麻醉，33例采用快速代谢药物全身麻醉。27例采用腹膜-颈内右静脉手术入路，3例采用腹膜-股静脉入路，将隐静脉与十字相连。在10例病例中，丹佛腹膜静脉分流术的放射学定位是通过锁骨下通路实现的。87.5%的患者腹水症状缓解，呼吸困难减轻，食欲增加，活动能力改善。丹佛腹膜静脉分流术是缓解恶性腹水的一种很好的装置，从而减少并发症的风险和因反复穿刺术而住院的次数，从而提高生活质量。仔细的患者选择、准确的随访和一些装置的改进可以改善分流性能，从而使丹佛腹膜静脉分流术得到更广泛的应用。
Malignant ascites is relatively common in patients with certain types of end-stage cancer. Traditional treatments based on fluid and salt restriction and diuretic therapy often are not able to contain neoplastic ascites. These patients consequently undergo repeated abdominal paracentesis, with further plasma protein loss and risk of injury to abdominal viscera. The aim of this study was to evaluate our experience with Denver peritoneovenous shunt and the outcome of patients with malignant ascites and suggest some modifications to improve device patency. From February 1997 to December 1999, 44 Denver peritoneovenous shunts were placed in 42 patients, 17 women and 25 men, aged between 38 and 77 years (mean, 62.3), affected with malignant ascites due to advanced abdominal cancer. At the time of admission, 72% of patients had pain, 88% dysphagia, 66% nausea and/or vomiting, and 83% dyspnea. Eleven patients underwent local anesthesia with lidocaine and 33 general anesthesia with rapidly metabolized drugs. In 27 cases we used the peritoneal-internal jugular right vein surgical approach and in 3 cases the peritoneal-femoral vein surgical access, joining the saphena vein to the cross. In 10 cases, a radiological positioning of the Denver peritoneovenous shunt was effected by a trans-subclavian access. Relief of ascites symptoms was obtained in 87.5% of cases, with reduction of dyspnea, an increased appetite and improved ambulation. Denver peritoneovenous shunt is a good device to relieve malignant ascites, thereby reducing the risk of complications and the number of hospital admissions due to repeated paracentesis and consequently improving the quality of life. A careful patient selection, an accurate follow-up and some device modifications could improve the shunt performance, allowing a wider application of the Denver peritoneovenous shunt.
原发肿瘤部位不明的腹膜癌病的治疗。
影响因子：
4
作者：
Muggia,FM;Baranda,J
通讯作者：
Baranda,J