腹腔-静脉分流术治疗难治性乳糜腹水的疗效分析

Peritoneovenous shunt for treatment of refractory chylous ascites

目的探讨腹腔-静脉分流术治疗难治性乳糜腹水的临床效果。方法回顾性分析2008年5月至2020年8月首都医科大学附属北京世纪坛医院淋巴外科应用腹腔-静脉分流术治疗40例难治性乳糜腹水患者的临床资料。结果患者术后体重[(57.8±13.2)kg]较术前[(65.9±13.1)kg]明显下降,术后腹围[(82.0±9.8)cm]较术前(94.3±10.8 cm)明显下降,术后24 h尿量[2 250(1 650,3 300)ml]较术前[750(500,1 000)ml]明显上升;术后血小板,纤维蛋白原,天门冬氨酸氨基转移酶、尿素、肌酐下降,凝血酶原时间延长(均P<0.05);活化部分凝血活酶时间(P=0.506)、丙氨酸氨基转移酶(P=0.154)、总蛋白(P=0.350)、白蛋白(P=0.113)变化差异无统计学意义。35例完成随访,失访5例,死亡29例,带管生存时间16(7,37)个月,存活6例,带管生存时间28(6,124)个月。结论腹腔-静脉分流术作为一种姑息性手术,针对其他方法治疗效果不佳或预期生存时间短的难治性乳糜腹水患者,可在有限的生存时间内改善其生存质量。

Objective To evaluate peritoneovenous shunt for treatment of refractory chylous ascites.Methods The clinical data of 40 patients with refractory chylous ascites treated by peritoneovenous shunt procedure at Department of Lymphatic Surgery,Beijing Shijitan Hospital,Capital Medical University from May 2008 to Aug 2020 were retrospectively analyzed.Results Patients'postoperative weight[(57.8±13.2)kg]was significantly lower than that of preoperative weight[(65.9±13.1)kg].Postoperative abdominal circumference significantly reduced[(82.0±9.8)cm vs.(94.3±10.8)cm].Average postoperative 24-hour urine output was significantly higher than that before operation[2250(1650,3300)ml vs.750(500,1000)ml].Platelet count and fibrinogen decreased after operation;prothrombin time(PT)prolonged;the change of time of activated partial thromboplastin(APTT)was not statistically significant(P=0.506).Postoperative aspartate aminotransferase(AST),urea,and creatinine decreased;whereas alanine aminotransferase(ALT)(P=0.154),total protein(P=0.350),and albumin(P=0.113)remained unchanged.35 patients got follow-up,29 deceased.The survival time with tube was 16(7,37)months;6 cases survived,the survival time with tube was 28(6,124)months.Conclusions Peritoneovenous shunt is a palliative surgery improving the quality of life of patients with refractory chylous ascites.