The Denver Tube Combined with Antiviral Drugs In the Treatment of HBV-related Cirrhosis with Refractory Ascites: A Report of Three Cases

Treatment of nucleos(t)ide antiviral drugs for decompensated HBV-related cirrhosis can significantly improve the prognosis. But those patients with refractory ascites possibly deteriorate due to the complications of ascites before any benefit from anti-viral drugs could be observed. Therefore, it is important to find a way to help the patients with HBV-related cirrhosis and refractory ascites to receive the full benefits from antiviral therapy. Peritoneovenous shunt(PVS) using Denver tube enables ascites to continuously bypass into systemic circulation, thereby reducing ascites and albumin input and improving quality of life. We report herein 3 cases of decompensated HBV-related cirrhosis with refractory ascites, PVS using Denver tube was combined with lamivudine for antiviral treatment before and after. Then, ascites was alleviated significantly or disapeared and viral responsed well. All patients achieved a satisfactory long-term survival from 6.7 to 14.7 years. It was suggested that the Denver shunt could be used as an adjuvant method to antiviral drugs for decompensated HBV-related cirrhosis with refractory ascites to help the patients reap the full benefits and maximize efficacy of antiviral treatment.

Denver置管术治疗顽固性腹水疗效随访

目的 :为了探讨Denver管腹腔颈静脉转流术对临床上难治性肝硬化腹水治疗的近期及远期疗效。方法 :我院自 1 994年 2月以来共治疗肝炎后肝硬化顽固性腹水病人 1 7例 ,其中术后一周内死亡 3例 ( 2例DIC ,1例心衰 ) ,总有效率为 82 3% ( 1 4 / 1 7)。本文对Denver置管术后 1 4例出院病人进行了 4— 6年疗效随访。结果 :现存活 3例 ,占 2 1 4 2 % ,1 1例已死亡 ,其中最长生存期为 2 2月 ,最短生存期为 3月 ,平均为 1 0 51± 7 0 4月。通过对 1 4例术后的体重、腹围、尿量、肝功能、输注白蛋白用量以及B超等多方面比较 ,可以看出患者的生活质量明显地提高。结论

Denver管腹腔静脉分流术治疗肝硬化难治性腹水的临床评价

目的 评价Denver管腹腔静脉分流术 (PVS)治疗肝硬化难治性腹水的效果。方法 选择 10例肝硬化难治性腹水病人置Denver管行腹腔颈内静脉分流术。手术前后观察病人的体重、尿量、腹围、生化指标和凝血指标以及生活质量的改变。结果 术后所有病人体重较术前平均降低 2 .7kg(P <0 .0 1) ,腹围平均减少 11.7cm (P <0 .0 1) ,尿量平均增加 10 5 3.8ml/d(P <0 .0 1) ,肌酐和尿素氮水平均有改善 (P <0 .0 5 ) ,但白蛋白、谷丙转氨酶和凝血酶原时间无明显变化。术后生活质量明显改善。术后并发症包括堵管 ( 2例 )、发烧 ( 2例 )、腹膜炎 ( 2例 )、心衰 ( 1例 )和上消化道出血 ( 2例 )。所有病人均有生化的DIC指标异常 ,但没有临床DIC表现 ,经处理后均缓解。结论 肝硬化难治性腹水行Denver管PVS后能明显增加尿量、降低体重、减小腹围和提高生活质量 ,虽然可有许多并发症发生 ,但是经积极处理后可以缓解 ,不少可积极预防。相信随临床经验的不断积累 ,其在肝硬化难治性腹水治疗中会起相当重要作用。