Yarmohammadi Hooman, Brody Lynn A, Erinjeri Joseph P, Covey Anne M, Boas F Edward, Ziv Etay, Maybody Majid, Gonzalez-Aguirre Adrian J, Brown Karen T, Sheinfeld Joel, Getrajdman George I
Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065.
Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065.
J Vasc Interv Radiol. 2016 May;27(5):665-73. doi: 10.1016/j.jvir.2015.12.014. Epub 2016 Mar 7.
To evaluate the safety and efficacy of percutaneous peritoneovenous shunt (PPVS) placement in treating intractable chylous ascites (CA) in patients with cancer.
Data from 28 patients with refractory CA treated with PPVS from April 2001 to June 2015 were reviewed. Demographic characteristics, technical success, efficacy, laboratory values, and complications were recorded. Univariate and multivariate logistic regression analysis was performed.
Technical success was 100%, and ascites resolved or symptoms were relieved in 92.3% (26 of 28) of patients. In 13 (46%) patients with urologic malignancies, whose ascites had resulted from retroperitoneal lymph node dissection, the ascites resolved, resulting in shunt removal within 128 days ± 84. The shunt provided palliation of symptoms in 13 of the remaining 15 patients (87%) for a mean duration of 198 days ± 214. Serum albumin levels increased significantly (21.4%) after PPVS placement from a mean of 2.98 g/dL ± 0.64 before the procedure to 3.62 g/dL ± 0.83 (P < .001). The complication rate was 37%, including shunt malfunction/occlusion (22%), venous thrombosis (7%), and subclinical disseminated intravascular coagulopathy (DIC) (7%). Smaller venous limb size (11.5 F) and the presence of peritoneal tumor were associated with a higher rate of shunt malfunction (P < .05). No patient developed overt DIC.
PPVS can safely and effectively treat CA in patients with cancer, resulting in significant improvement in serum albumin in addition to palliation of symptoms.
评估经皮腹腔静脉分流术（PPVS）治疗癌症患者顽固性乳糜腹水（CA）的安全性和有效性。
回顾了2001年4月至2015年6月期间接受PPVS治疗的28例难治性CA患者的数据。记录人口统计学特征、技术成功率、疗效、实验室检查值和并发症情况。进行单因素和多因素逻辑回归分析。
技术成功率为100%，92.3%（28例中的26例）的患者腹水消退或症状缓解。13例（46%）泌尿系统恶性肿瘤患者的腹水由腹膜后淋巴结清扫引起，腹水消退，分流管在128天±84天内拔除。在其余15例患者中的13例（87%），分流管缓解了症状，平均持续时间为198天±214天。PPVS置入后血清白蛋白水平显著升高（21.4%），术前平均为2.98 g/dL±0.64，术后为3.62 g/dL±0.83（P<.001）。并发症发生率为37%，包括分流管功能障碍/堵塞（22%）、静脉血栓形成（7%）和亚临床弥散性血管内凝血（DIC）（7%）。较小的静脉支管径（11.5F）和存在腹膜肿瘤与较高的分流管功能障碍发生率相关（P<.05）。无患者发生明显的DIC。
PPVS可安全有效地治疗癌症患者的CA，除缓解症状外，还可使血清白蛋白显著改善。
