Franco D, Meakins J L, Wu A, Smadja C, Bonnet P, Gouffier E, Campillo B
Groupe de Recherche sur la Chirurgie du Foie et de l'Hypertension Portale, Hôpital Paul Brousse, Villejuif, France.
HPB Surg. 1989 Oct;1(3):185-91, discussion 191-4. doi: 10.1155/1989/48305.
This report is based on twenty-eight (26%) of 107 patients included in a protocol for prospective evaluation of elective peritoneo-venous shunting for intractable ascites in cirrhosis. These patients had no other procedures and survived more than 5 years after the operation. All patients were free of ascites except one in whom it was mild. One patient refused follow-up. Shunt patency was assessed in 23 patients In 14 patients (60.9%), the shunt was obstructed and the superior vena cava was occluded in 5 of them. In 9 patients (39.1%), the shunt was still functioning. No clinical or biological parameters differentiated these two groups of patients. Of the 24 patients who were alcoholics, 2 abstained completely and 20 significantly reduced their drinking habits. In 25 patients, the Pugh's score improved and was A at the time of the study. Seven patients (25.9%) developed a malignant tumor of the oro-pharynx or digestive tract, all other patients were alive and in good health. This study suggests that patients with intractable ascites treated by a peritoneo-venous shunt may survive for a long period. In patients abstaining from heavy drinking, it may function as a therapeutic bridge permitting spontaneous improvement of liver function. The risk of supervening neoplasms suggests that a continuous follow-up of these patients is warranted.
本报告基于一项针对肝硬化顽固性腹水择期腹膜静脉分流术进行前瞻性评估的方案中纳入的107例患者中的28例（26%）。这些患者未接受其他手术，术后存活超过5年。除1例腹水轻微外，所有患者均无腹水。1例患者拒绝随访。对23例患者评估了分流管通畅情况。14例患者（60.9%）的分流管阻塞，其中5例上腔静脉闭塞。9例患者（39.1%）的分流管仍在发挥作用。没有临床或生物学参数能区分这两组患者。在24例酗酒患者中，2例完全戒酒，20例饮酒习惯显著减少。25例患者的Pugh评分改善，研究时为A级。7例患者（25.9%）发生口咽或消化道恶性肿瘤，其他所有患者均存活且健康状况良好。本研究表明，接受腹膜静脉分流术治疗的顽固性腹水患者可能长期存活。在戒酒的患者中，它可能起到治疗桥梁的作用，使肝功能自发改善。后续发生肿瘤的风险表明，对这些患者进行持续随访是必要的。
