Smith D A, Weaver D W, Bouwman D L
Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan.
Am Surg. 1989 Jul;55(7):445-9.
Fifty cases of malignant ascites were studied to determine what factors influenced outcome after peritoneovenous shunt. There were 36 women and 14 men. The five most common tumor types were colon, breast, gastric, pancreatic, and unspecified adenocarcinoma. Multivariate analysis between those patients surviving longer than 7 weeks (n = 20) and those who died in less than 7 weeks (n = 30) showed that women did uniformly better than men, even excluding the "female malignancies" (P less than 0.01). An elevated white blood cell count (WBC) and low platelets also were strong predictors of poor outcome (P less than 0.5 for difference in means between the two groups). Patients with pancreatic cancer and ascites fared poorly (80% mortality by 7 weeks) as did those with colon cancer (73% mortality by 7 weeks). By contrast, 50 per cent of the patients with breast and gastric cancer lived more than 7 weeks. Twelve patients had a LaVeen shunt placed, compared with 38 who had a Denver shunt. Fifty per cent of the La Veen shunts failed, with a mean time to failure of 69 days (P less than 0.01). Shunt failure, however, had no influence on overall survival.
对50例恶性腹水患者进行了研究，以确定哪些因素会影响腹腔静脉分流术后的预后。其中有36名女性和14名男性。五种最常见的肿瘤类型为结肠癌、乳腺癌、胃癌、胰腺癌和未明确的腺癌。对存活超过7周的患者（n = 20）和在7周内死亡的患者（n = 30）进行多因素分析，结果显示，即使排除“女性恶性肿瘤”，女性的预后总体上也优于男性（P < 0.01）。白细胞计数（WBC）升高和血小板计数低也是预后不良的有力预测指标（两组均值差异P < 0.5）。胰腺癌合并腹水的患者预后较差（7周时死亡率为80%），结肠癌患者也是如此（7周时死亡率为73%）。相比之下，乳腺癌和胃癌患者中有50%存活超过7周。12例患者植入了LeVeen分流管，38例患者植入了Denver分流管。50%的LeVeen分流管失败，平均失败时间为69天（P < 0.01）。然而，分流管失败对总体生存率没有影响。
