Interventional Radiology Service, Department of Radiology, New York, New York.
Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York.
J Urol. 2020 Oct;204(4):818-823. doi: 10.1097/JU.0000000000001121. Epub 2020 May 5.
We investigated the efficacy and analyzed the complication risk factors of peritoneovenous shunt in treating refractory chylous ascites following retroperitoneal lymph node dissection in patients with urological malignancies.
From April 2001 to March 2019 all patients with refractory chylous ascites after retroperitoneal lymph node dissection treated with peritoneovenous shunt were reviewed. Demographic characteristics, technical success, efficacy, patency period and complications were studied. Univariate and multivariate logistic regression analysis was performed to identify predictors of complications.
Twenty patients were included in this study. Testicular cancer was the most common malignancy (85%). The mean number of days from surgery to detection of chylous ascites was 21 days (SD 15, range 4 to 65). Ascites permanently resolved after peritoneovenous shunt in 18 patients (90%), leading to shunt removal in 17 patients (85%) between 46 and 481 days (mean 162, SD 141). The mean serum albumin level increased 24% after shunt placement (mean 3.0±0.6 gm/dl before, 3.9±0.8 gm/dl after, p <0.05). The most common complication was occlusion (30%). Relative risk of complications increased significantly when shunt placement was more than 70 days after surgery and in patients with more than 5 paracenteses before peritoneovenous shunt placement (AR 0.71% vs 0.25%, RR 2.9, p <0.048 and AR 0.6% vs 0.125%, RR 4.8, p <0.04, respectively).
Peritoneovenous shunt permanently treated chylous ascites in 90% of patients after retroperitoneal lymph node dissection. Peritoneovenous shunt was removed in 85% of patients. Shunt placement is an effective and safe treatment option for refractory chylous ascites. These patients might benefit from earlier intervention, after 4 to 6 weeks of conservative management as opposed to 2 to 3 months.
研究分析腹膜静脉分流术治疗尿路上皮恶性肿瘤患者腹膜后淋巴结清扫术后难治性乳糜性腹水的疗效和并发症危险因素。
回顾性分析 2001 年 4 月至 2019 年 3 月期间因腹膜后淋巴结清扫术后难治性乳糜性腹水行腹膜静脉分流术的所有患者。研究内容包括人口统计学特征、技术成功率、疗效、通畅期和并发症。采用单因素和多因素 logistic 回归分析确定并发症的预测因素。
本研究共纳入 20 例患者。最常见的恶性肿瘤是睾丸癌（85%）。从手术到发现乳糜性腹水的平均天数为 21 天（标准差 15，范围 4 至 65）。18 例（90%）患者的乳糜性腹水经腹膜静脉分流术后永久性缓解，17 例（85%）患者在 46 至 481 天（平均 162，标准差 141）之间拔除分流管。分流管放置后血清白蛋白水平平均升高 24%（放置前 3.0±0.6g/dl，放置后 3.9±0.8g/dl，p<0.05）。最常见的并发症是分流管阻塞（30%）。当分流管放置时间超过手术 70 天和分流管放置前进行超过 5 次穿刺时，并发症的相对风险显著增加（AR 0.71%vs0.25%，RR2.9，p<0.048 和 AR 0.6%vs0.125%，RR4.8，p<0.04）。
腹膜静脉分流术可永久性治疗腹膜后淋巴结清扫术后难治性乳糜性腹水，90%的患者。85%的患者拔除了分流管。分流管放置是治疗难治性乳糜性腹水的一种有效且安全的治疗选择。这些患者可能受益于早期干预，即在保守治疗 4 至 6 周后，而不是 2 至 3 个月后进行干预。
