Stehman F B, Ehrlich C E
Gynecol Oncol. 1984 Jul;18(3):402-7. doi: 10.1016/0090-8258(84)90052-0.
Peritoneo-venous shunting has been used extensively in the treatment of benign ascites and, to a limited extent, in the palliative management of malignant ascites. Acceptance of this therapy for malignant ascites has been slow because of concern over intravascular dissemination of disease. Recently a patient with advanced drug-resistant ovarian carcinoma was treated with peritoneo-cystic shunt. This patient's tumor had progressed on multiple chemotherapeutic agents. She continued to work 40 hr per week but her activity was limited by massive ascites. The Denver Shunt (Storz) was selected in preference to the strut-type shunt. The Denver Shunt has a miter valve which is less likely to become occluded by fibrinous and cellular debris, and manual compression of the pumping chamber allows flushing and control of flow. This patient's shunt remained patent for 5 months, until her death, documented by urine cytology and cystoscopy. Initial control of ascites was only fair, probably due to the virtual absence of a pressure gradient between the peritoneal cavity and the bladder. Without a pressure gradient, spontaneous flow would be expected to be nil. Though feasible and well tolerated, this technique is probably not useful in the management of malignant ascites. If modifications of the device could be made to increase the manual flow rate, then this technique might be acceptable.
腹腔静脉分流术已广泛应用于良性腹水的治疗，并在一定程度上用于恶性腹水的姑息治疗。由于担心疾病在血管内播散，这种治疗恶性腹水的方法接受度一直不高。最近，一名晚期耐药卵巢癌患者接受了腹腔-囊肿分流术治疗。该患者的肿瘤对多种化疗药物均已进展。她继续每周工作40小时，但因大量腹水而活动受限。选择了丹佛分流管（史托斯公司）而非支撑型分流管。丹佛分流管有一个斜接阀，不太容易被纤维蛋白和细胞碎片阻塞，手动按压泵腔可进行冲洗和流量控制。该患者的分流管在5个月内保持通畅，直至其死亡，尿液细胞学检查和膀胱镜检查证实了这一点。腹水的初始控制效果一般，可能是由于腹腔和膀胱之间几乎没有压力梯度。没有压力梯度，预计自然流量为零。尽管该技术可行且耐受性良好，但可能对恶性腹水的治疗没有帮助。如果能对该装置进行改进以提高手动流速，那么这种技术可能是可以接受的。
