Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
J Vasc Surg Venous Lymphat Disord. 2017 Jul;5(4):538-546. doi: 10.1016/j.jvsv.2017.03.011. Epub 2017 May 9.
The purpose of this study was to define outcome of treatments of refractory chylous ascites using peritoneovenous shunts (PVSs).
Clinical data of patients with refractory chylous ascites treated with PVSs between 1992 and 2015 were retrospectively reviewed. The primary end point was clinical benefit, defined as cured, improved, or poor results; secondary end points were complications and reinterventions.
Seventeen patients (eight female [47%]; median age, 47 years [range, 19-78 years]) with refractory chylous ascites were studied. This group represented 6% of 284 patients treated for chylous ascites during the study period. The etiology was primary lymphangiectasia in 10 patients (59%) and secondary chylous ascites due to previous surgery, lymphatic obstruction with associated portal hypertension, or malignant tumor in 7 (41%). Eleven patients were treated with LeVeen shunts and six with Denver shunts. Thirty-day mortality, morbidity, and reintervention rates were 5.9%, 18%, and 12%, respectively. Reintervention rate at 6 months was 9.1% with LeVeen shunt, significantly lower than 100% with Denver shunt (P = .001). During a mean follow-up of 5.1 years (range, 17 days-22.7 years), 7 of 11 patients with LeVeen shunt and all 6 patients with Denver shunt required shunt replacement. Median duration of patency was 215 days (range, 2 days-9.0 years) of a total of 25 LeVeen shunts placed in 11 patients and 44 days (range, 6-91 days) of 20 Denver shunts placed in 6 patients. At last follow-up, patency of the LeVeen shunt was 36% (4/11); symptoms improved in 64% of the patients (7/11). Patency rate of Denver shunts was 33% (2/6), and symptoms improved in 33% (2/6).
Treatment of refractory chylous ascites continues to be a major challenge. The only currently available PVS, the Denver shunt, had a median patency period of <2 months; it required frequent replacements and resulted in intermittent short-term clinical benefit in one-third of the patients. Improvements in technology to design new shunts, to develop new therapies, or to adopt new techniques to treat chylous ascites are urgently needed.
本研究旨在定义使用腹膜静脉分流术（PVS）治疗难治性乳糜性腹水的治疗结果。
回顾性分析了 1992 年至 2015 年间接受 PVS 治疗的难治性乳糜性腹水患者的临床资料。主要终点为临床获益，定义为治愈、改善或预后不良；次要终点为并发症和再干预。
研究纳入了 17 例难治性乳糜性腹水患者（8 例女性[47%]；中位年龄 47 岁[范围，19-78 岁]）。这组患者占研究期间 284 例乳糜性腹水患者的 6%。病因是原发性淋巴管扩张 10 例（59%），继发乳糜性腹水是由于先前的手术、淋巴阻塞伴相关门静脉高压或恶性肿瘤 7 例（41%）。11 例患者接受 LeVeen 分流术，6 例接受 Denver 分流术。30 天死亡率、发病率和再干预率分别为 5.9%、18%和 12%。LeVeen 分流术的 6 个月再干预率为 9.1%，明显低于 Denver 分流术的 100%（P=0.001）。在平均 5.1 年（范围，17 天-22.7 年）的随访中，11 例接受 LeVeen 分流术的患者中有 7 例和 6 例接受 Denver 分流术的患者均需要更换分流术。总共在 11 例患者中放置了 25 个 LeVeen 分流管，中位通畅时间为 215 天（范围，2 天-9.0 年）；在 6 例患者中放置了 20 个 Denver 分流管，中位通畅时间为 44 天（范围，6-91 天）。在最后一次随访时，LeVeen 分流术的通畅率为 36%（4/11）；64%的患者症状改善（7/11）。Denver 分流术的通畅率为 33%（2/6），33%的患者症状改善（2/6）。
难治性乳糜性腹水的治疗仍然是一个主要挑战。目前唯一可用的 PVS，即 Denver 分流术，其中位通畅期<2 个月；它需要频繁更换，并导致三分之一的患者出现间歇性短期临床获益。迫切需要改进技术来设计新的分流术、开发新的治疗方法或采用新的技术来治疗乳糜性腹水。
