Vizsy László, Beznicza Henrietta, Bátorfi József
Nagykanizsa Megyei Jogú Város Kórháza, Altalános Sebészeti Osztály.
Orv Hetil. 2004 Feb 29;145(9):479-81.
The price and complication rates of pump models applied in the treatment of intractable ascites are significantly high. The development of a more simple, cheaper technique--using the biologically given venous valves--the saphenoperitoneal shunts became essential.
In authors' department 11 saphenoperitoneal shunts have been performed on 9 patients from 01.01.2001. to 01.04.2002. After operation significant reduction in abdominal girth and increase in diuresis with diuretics in unchanged doses were observed in 6 patients decreasing their dyscomfort. In one of the patients the ligation of fistula have been needed due to peritoneal reflux, in another one severe hypoproteinaemia have developed. In 3 cases shunt occlusions have appeared: one of them have got Denver-shunt, in other case contralateral saphenoperitoneal shunt have been created with PTFE prosthesis implantation, in the third patient desobliteration have been performed with silicone drain.
Significant improvement of quality of life would be caused by saphenoperitoneal shunts with minimal negative operative effects in successful cases. Besides this method is cost-effective, and has moderate and well corrigable hemodynamic effects.
用于治疗顽固性腹水的泵模型价格高昂且并发症发生率显著较高。因此,开发一种更简单、更便宜的技术——利用生物自带的静脉瓣膜,即大隐静脉-腹膜分流术变得至关重要。
在作者所在科室,从2001年1月1日至2002年4月1日,对9例患者实施了11次大隐静脉-腹膜分流术。术后,6例患者腹围显著减小,使用剂量不变的利尿剂时尿量增加,不适症状减轻。其中1例患者因腹膜反流需要结扎瘘管,另1例患者出现了严重的低蛋白血症。3例出现分流闭塞:1例使用的是丹佛分流器,另1例通过植入聚四氟乙烯假体建立了对侧大隐静脉-腹膜分流术,第3例患者使用硅胶引流管进行了再通术。
在成功的病例中,大隐静脉-腹膜分流术可显著改善生活质量,且手术负面影响极小。此外,该方法具有成本效益,对血流动力学的影响适中且易于纠正。