摘要
目的 分析Denver管腹腔静脉分流术 (PVS)临床运用的并发症及其处理的效果。方法 回顾性分析 2 0例行PVS术后患者的近远期并发症的类型和发生率 ,统计各项处理措施的效果和术后患者生存率。结果 共有 2 9例次 9类 ( 12种 )并发症发生 ,近期 ( <1月 ) 19例次 ,中远期 ( >1月 ) 10例次 ,1年堵管率为 5 %。共有 13例 ( 65 % )患者出现并发症 ,9例 ( 4 5 % )为近期并发症 ,9例 ( 65 % )为中远期并发症 ,有 4种并发症导致了随后患者的死亡。肝硬化难治性腹水者术后 1年生存率为 2 4% ,生存期小于半年的主要影响因素是高龄和ChildC级。与PVS术直接相关的死亡原因是败血症、上消化道出血和DIC。结论 Denver管PVS术后半数以上患者出现并发症 ,经积极处理后大多数近期并发症可以缓解 ,不少可积极预防 ,中远期并发症缓解率极低 ,部分可能原因是随访指导不够和不能及时治疗。只要合理选择患者 ,术前积极准备 ,改善置管技术 ,术后积极预防并发症 ,加强随访和及时治疗并发症 ,PVS在肝硬化难治性腹水及癌性腹水治疗中仍可发挥一定作用。
Objective To analyze the complications of Denver peritoneovenous shunting and the results of management.Methods The records of 20 consecutive patients treated with Denver type shunting tubes were reviewed to analyze the frequency of complications, the results of the management and the rate of patient survival.Results Twenty nine complications(9 types) including nineteen early (<l month) and ten late (>l month) were identified in 13(65%) patients and, in 4 instances, led to subsequent death. Nine patients each had early and late complications. The one year survival rate of patients with cirrhosis treated with the Denver shunt was 25% and the death within 6 months was related to age and Child C degree. The main causes of death related to the Denver shunt directly were varice bleeding, infection and DIC.Conclusions Over half of the patients experienced complications with the Denver shunt. Most patients with early complications remained in remission, but those with late complications had poor prognosis. Careful selection of patients, good preparation, improved surgical techniques, prevention of complications and careful follow up augment the benefits of the Denver shunt.
出处
《肝脏》
2003年第1期25-27,共3页
Chinese Hepatology
