Therapeutic Application of Percutaneous Peritoneovenous (Denver) Shunt in Treating Chylous Ascites in Cancer Patients

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• 作者：Hooman Yarmohammadi ; MD<sup>asup><sup> ; sup><sup>yarmohah@mskcc.org" class="auth_mail" title="E-mail the corresponding authorsup> ; Lynn A. Brody ; MD<sup>asup> ; Joseph P. Erinjeri ; MD ; PhD<sup>asup> ; Anne M. Covey ; MD<sup>asup> ; F. Edward Boas ; MD ; PhD<sup>asup> ; Etay Ziv ; MD ; PhD<sup>asup> ; Majid Maybody ; MD<sup>asup> ; Adrian J. Gonzalez-Aguirre ; MD<sup>asup> ; Karen T. Brown ; MD<sup>asup> ; Joel Sheinfeld ; MD<sup>bsup> ; George I. Getrajdman ; MD<sup>asup>
• 关键词：CA ; chylous ascites ; DIC ; disseminated intravascular coagulopathy ; LAM ; lymphangioleiomyomatosis ; LND ; lymph node dissection ; PPVS ; percutaneous peritoneovenous shunt
• 刊名：Journal of Vascular and Interventional Radiology
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：27
• 期：5
• 页码：665-673
• 全文大小：424 K

文摘

To evaluate the safety and efficacy of percutaneous peritoneovenous shunt (PPVS) placement in treating intractable chylous ascites (CA) in patients with cancer.

sSec_2">Materials and Methods

sp0045">Data from 28 patients with refractory CA treated with PPVS from April 2001 to June 2015 were reviewed. Demographic characteristics, technical success, efficacy, laboratory values, and complications were recorded. Univariate and multivariate logistic regression analysis was performed.

sSec_3">Results

sp0050">Technical success was 100%, and ascites resolved or symptoms were relieved in 92.3% (26 of 28) of patients. In 13 (46%) patients with urologic malignancies, whose ascites had resulted from retroperitoneal lymph node dissection, the ascites resolved, resulting in shunt removal within 128 days &plusmn; 84. The shunt provided palliation of symptoms in 13 of the remaining 15 patients (87%) for a mean duration of 198 days &plusmn; 214. Serum albumin levels increased significantly (21.4%) after PPVS placement from a mean of 2.98 g/dL &plusmn; 0.64 before the procedure to 3.62 g/dL &plusmn; 0.83 (P < .001). The complication rate was 37%, including shunt malfunction/occlusion (22%), venous thrombosis (7%), and subclinical disseminated intravascular coagulopathy (DIC) (7%). Smaller venous limb size (11.5 F) and the presence of peritoneal tumor were associated with a higher rate of shunt malfunction (P < .05). No patient developed overt DIC.

sSec_4">Conclusions

sp0055">PPVS can safely and effectively treat CA in patients with cancer, resulting in significant improvement in serum albumin in addition to palliation of symptoms.