Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan.
Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan.
Tomography. 2024 Mar 25;10(4):471-479. doi: 10.3390/tomography10040036.
Refractory ascites affects the prognosis and quality of life in patients with liver cirrhosis. Peritoneovenous shunt (PVS) is a treatment procedure of palliative interventional radiology for refractory ascites. Although it is reportedly associated with serious complications (e.g., heart failure, thrombotic disease), the clinical course of PVS has not been thoroughly evaluated.
To evaluate the relationship between chronological course and complications after PVS for refractory ascites in liver cirrhosis patients.
This was a retrospective study of 14 patients with refractory ascites associated with decompensated cirrhosis who underwent PVS placement between June 2011 and June 2023. The clinical characteristics, changes in cardiothoracic ratio (CTR), and laboratory data (i.e., brain natriuretic peptide (BNP), D-dimer, platelet) were evaluated. Follow-up CT images in eight patients were also evaluated for ascites and complications.
No serious complication associated with the procedure occurred in any case. Transient increases in BNP and D-dimer levels, decreased platelet counts, and the worsening of CTR were observed in the 2 days after PVS; however, they were improved in 7 days in all cases except one. In the follow-up CT, the amount of ascites decreased in all patients, but one patient with a continuous increase in D-dimer 2 and 7 days after PVS had thrombotic disease (renal and splenic infarction). The mean PVS patency was 345.4 days, and the median survival after PVS placement was 474.4 days.
PVS placement for refractory ascites is a technically feasible palliative therapy. The combined evaluation of chronological changes in BNP, D-dimer, platelet count and CTR, and follow-up CT images may be useful for the early prediction of the efficacy and complications of PVS.
难治性腹水会影响肝硬化患者的预后和生活质量。经皮经腔静脉分流术（PVS）是一种难治性腹水的姑息性介入放射学治疗方法。尽管它与严重的并发症（如心力衰竭、血栓性疾病）有关，但 PVS 的临床过程尚未得到彻底评估。
评估肝硬化患者难治性腹水行 PVS 后时间进程与并发症的关系。
这是一项回顾性研究，纳入了 2011 年 6 月至 2023 年 6 月期间因失代偿性肝硬化伴难治性腹水而行 PVS 置管的 14 例患者。评估了临床特征、心胸比（CTR）变化以及实验室数据（即脑利钠肽（BNP）、D-二聚体、血小板）。还对 8 例患者的随访 CT 图像进行了腹水和并发症评估。
在任何情况下均未发生与该操作相关的严重并发症。PVS 后 2 天观察到 BNP 和 D-二聚体水平短暂升高、血小板计数下降和 CTR 恶化，但除 1 例外所有患者在 7 天内均得到改善。在随访 CT 中，所有患者的腹水均减少，但 1 例患者在 PVS 后 2 天和 7 天 D-二聚体持续升高，发生了血栓性疾病（肾和脾梗死）。PVS 通畅的平均时间为 345.4 天，PVS 置管后中位生存时间为 474.4 天。
难治性腹水的 PVS 置管是一种可行的姑息性治疗技术。联合评估 BNP、D-二聚体、血小板计数和 CTR 的时间变化以及随访 CT 图像，可能有助于早期预测 PVS 的疗效和并发症。
