Cattaneo U, Enrico S, Serra G C, Bergoglio D, Corno F, Fronda G R
Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli Studi di Torino.
Minerva Gastroenterol Dietol. 1993 Sep;39(3):119-26.
The authors consider the various causes of ascites and they also develop the concept of refractory ascites. They consider the various possibilities of medical and dietary therapy whose failure constitutes the basis for a surgical approach. In the latter case it is being considered the Peritoneo Venous Shunt (PVS) that employs different types of valves. In the light of their personal experience, matured over a period of 15 years, in which 75 valves were positioned in 64 patients and precisely: 55 valves of Le Veen, 15 Hakim and 5 Denver, it is emphasized that the best results, as for as mortality and morbidity goes, were obtained through careful attention in the preoperative stage and during surgery itself with the privileged use of a Le Veen's valve. For such motives, since in a high percentage of these patients there persists a poor prognosis a year away from the onset of refractory ascites, a PVS seems proposable anyway and even though this will not alter the pathological outcome, there's a clear improvement in the quality of life without precluding any other surgical approach. Finally, the authors outline the possibilities offered by the Transjugular Intrahepatic Portosystemic Shunt (TIPS), as a new original approach for the resolution of refractory ascites.
作者们探讨了腹水的各种病因，还提出了顽固性腹水的概念。他们考虑了药物和饮食治疗的各种可能性，而这些治疗方法的失败构成了采取手术治疗的基础。在后一种情况下，正在考虑采用使用不同类型瓣膜的腹腔静脉分流术（PVS）。根据他们15年来积累的个人经验，在此期间为64例患者植入了75个瓣膜，具体情况为：55个Le Veen瓣膜、15个Hakim瓣膜和5个Denver瓣膜，强调就死亡率和发病率而言，通过在术前阶段以及手术过程中予以密切关注，并优先使用Le Veen瓣膜，可取得最佳效果。出于这些原因，鉴于在这些患者中很大一部分人在顽固性腹水出现一年后预后仍然很差，无论如何PVS似乎都是可行的，尽管这不会改变病理结果，但在不排除任何其他手术方法的情况下，生活质量有明显改善。最后，作者们概述了经颈静脉肝内门体分流术（TIPS）作为解决顽固性腹水的一种新的独创方法所提供的可能性。
