Cheung D K, Raaf J H
Cancer. 1982 Sep 15;50(6):1204-9. doi: 10.1002/1097-0142(19820915)50:6<1204::aid-cncr2820500631>3.0.co;2-w.
Twenty-two patients with intractable malignant ascites who received a peritoneovenous shunt were studied. We found that the peritoneovenous shunt functioned longer in patients whose ascitic fluid was negative for malignant cells. The median shunt survival in alive patients in the negative cytologic group was 140 days compared to 26 days in the positive cytologic group (P = 0.01). The overall survival of these patients was poor, with a median of 32 days. Median survival of patients with positive cytologic results (26 days) was significantly worse than for the cytologically negative group (80 days; P = 0.05). The incidence of tumor emboli, confirmed at autopsy, was estimated to be about 5%. Seventy-five percent of all complications occurred in the group of patients with a positive cytologic result. We conclude that a positive ascites fluid cytologic finding is a relative contraindication to placement of a peritoneovenous shunt since this is associated with early shunt failure, postoperative coagulopathy, infection, and tumor emboli. However, since the serious complication rate is only 4% and tumor emboli rate 5%, peritoneovenous shunting in symptomatic patients with cytologically negative malignant ascites is a useful palliative procedure.
对22例接受腹腔静脉分流术的顽固性恶性腹水患者进行了研究。我们发现，腹水癌细胞阴性的患者腹腔静脉分流术的功能维持时间更长。细胞学检查阴性组存活患者的分流术中位生存期为140天，而细胞学检查阳性组为26天（P = 0.01）。这些患者的总体生存期较差，中位生存期为32天。细胞学检查结果阳性患者的中位生存期（26天）明显短于细胞学检查阴性组（80天；P = 0.05）。经尸检证实的肿瘤栓子发生率估计约为5%。所有并发症的75%发生在细胞学检查结果阳性的患者组中。我们得出结论，腹水细胞学检查结果阳性是腹腔静脉分流术的相对禁忌证，因为这与分流术早期失败、术后凝血功能障碍、感染和肿瘤栓子有关。然而，由于严重并发症发生率仅为4%，肿瘤栓子发生率为5%，对于有症状的细胞学检查阴性的恶性腹水患者，腹腔静脉分流术是一种有用的姑息治疗方法。
