Denver管腹腔静脉分流术治疗肝硬化难治性腹水的临床评价

目的评价Denver管腹腔静脉分流术(PVS)治疗肝硬化难治性腹水的效果.方法选择10例肝硬化难治性腹水病人置Denver管行腹腔颈内静脉分流术.手术前后观察病人的体重、尿量、腹围、生化指标和凝血指标以及生活质量的改变.结果术后所有病人体重较术前平均降低2.7kg(P＜0.01),腹围平均减少11.7cm(P＜0.01),尿量平均增加1053.8ml/d(P＜0.01),肌酐和尿素氮水平均有改善(P＜0.05),但白蛋白、谷丙转氨酶和凝血酶原时间无明显变化.术后生活质量明显改善.术后并发症包括堵管(2例)、发烧(2例)、腹膜炎(2例)、心衰(1例)和上消化道出血(2例).所有病人均有生化的DIC指标异常,但没有临床DIC表现,经处理后均缓解.结论肝硬化难治性腹水行Denver管PVS后能明显增加尿量、降低体重、减小腹围和提高生活质量,虽然可有许多并发症发生,但是经积极处理后可以缓解,不少可积极预防.相信随临床经验的不断积累,其在肝硬化难治性腹水治疗中会起相当重要作用.

A study on the peritoneovenous shunting by the Denver tubes for cirrhosis with refractory ascites

Objective To evaluate the role of the peritoneovenous shunt(PVS) by Denver catheter in the treatment of refractory cirrhotic ascites. Methods Between 1998 and 2000, the PVS by Denver catheters were placed subcutaneously on 10 cirrhotic patients with refractory ascites. Body weight, urinary output, abdominal girth, biochemical and coagulate parameters and quality of life were observed. Results Reduced ascites was noted postoperatively with statistical significance in all patients(P<0.01), of whom exhibited body weight reduced by 2.7 kg and abdominal girth reduced by 11.7cm in two weeks. A larger urinary output was also noted with a mean increase of 1053.8ml/day compared with the pre-shunting output (P<0.01) in two weeks. All patients improved in the renal function parameters (P<0.05). There are no changes on the level of ALT, album and PT before and after PVS. All patients had the laboratory abnormal on DIC parameters but without clinical DIC sign. The complications included fever(2), shunt obstruction(1), peritonitis(2), heart failure(1)and variceal bleeding(2) were recovered by relevant management.Conclusion Denver shunt could be an effective alterative measure for the treatment of refractory ascites in clinical practice.