O'Connor M, Allen J I, Schwartz M L
Ann Surg. 1984 Jul;200(1):66-9. doi: 10.1097/00000658-198407000-00011.
Review of clinical and operative records of 86 patients at the Minneapolis VA Medical Center and Mount Sinai Hospital undergoing peritoneovenous (PV) shunt for intractable ascites revealed a subgroup of patients (n = 9) who developed leaking ascites prior to shunting. The etiology of leaking ascites was as follows: 1) ruptured umbilical hernia ( UH ) (four patients), 2) repeated paracentesis (three patients), and 3) postoperative incisional ascitic fluid leak (two patients). Initial therapy included local sterile compression dressing, intravenous antibiotics, and management of fluid and electrolytes. All nine patients underwent subsequent closure of the fascial defect and PV shunt to prevent reaccumulation of ascites (simultaneous procedures were performed in five patients). No patient developed postoperative septic complications, organ failure, gastrointestinal bleeding, or encephalopathy. There were no early deaths; however, three late deaths (18 months, 2, and 4 years) were due to variceal bleeding and/or liver failure. Ascites was well controlled in seven patients with PV shunt alone, the other two ultimately responding to medical therapy. We conclude that peritoneal fluid leaks can be treated successfully by repairing the fascial defect and placing a PV shunt. In the absence of infected ascites and clinical peritonitis, PV shunt may be performed simultaneously with closure of UH , thus preventing the reaccumulation of ascites during the immediate postoperative period.
回顾明尼阿波利斯退伍军人事务医疗中心和西奈山医院86例因顽固性腹水接受腹腔静脉（PV）分流术患者的临床和手术记录，发现有一组患者（n = 9）在分流术前出现腹水渗漏。腹水渗漏的病因如下：1）脐疝破裂（UH）（4例患者），2）反复腹腔穿刺（3例患者），以及3）术后切口腹水渗漏（2例患者）。初始治疗包括局部无菌加压包扎、静脉使用抗生素以及液体和电解质管理。所有9例患者随后均进行了筋膜缺损修复和PV分流术，以防止腹水再次积聚（5例患者同时进行了这两种手术）。没有患者出现术后感染并发症、器官衰竭、胃肠道出血或脑病。没有早期死亡病例；然而，有3例晚期死亡（分别在18个月、2年和4年）是由于静脉曲张出血和/或肝功能衰竭。仅PV分流术就使7例患者的腹水得到了良好控制，另外2例最终通过药物治疗得到缓解。我们得出结论，通过修复筋膜缺损和放置PV分流术可以成功治疗腹膜液渗漏。在没有感染性腹水和临床腹膜炎的情况下，可以在关闭脐疝的同时进行PV分流术，从而防止术后早期腹水再次积聚。
