https://scholars.lib.ntu.edu.tw/handle/123456789/521536
標題: | Salvaging procedures for dysfunctional peritoneovenous shunt | 作者: | REY-HENG HU PO-HUANG LEE |
公開日期: | 2001 | 卷: | 48 | 期: | 39 | 起(迄)頁: | 794-797 | 來源出版物: | Hepato-Gastroenterology | 摘要: | Background/Aims: Peritoneovenous shunt is one of the treatments for refractory ascites. However, the dysfunction of the shunt is frequently seen and needs farther management. We in this manuscript reported our experience in the salvaging procedures of dysfunctional peritoneovenous shunt. Methodology: A total of 29 Denver shunts were constructed for the management of refractory ascites at the Department of Surgery, National Taiwan University Hospital since January 1992 to February 1999. A cross-sectional case study was performed. Results: There was a total of 20 cases of mechanical dysfunction for these 29 patients. In the management of 6 peritoneal catheter occlusions which occurred in the early phase of this series, revision was performed by lengthening of the peritoneal catheter with a peritoneal dialysis catheter so that the catheter tip could rest in the Douglas pouch. The same procedure was adopted in the last 14 consecutive Denver shunts and this significantly decreased the incidence of peritoneal catheter occlusion (6/15 vs. 0/14, P=0.011 by Fisher's exact test). In the 6 episodes of valve occlusion, the reservoir of the Denver shunt was replaced with a new one but the peritoneal and venous catheters were not changed. In the 8 episodes of venous catheter dysfunction, two venous catheters slipping out were managed by lengthening the catheter with a large-bore Hickmann catheter. In the other 6 episodes, a new venous catheter was inserted to the other side of the internal jugular vein or saphenous vein through a subcutaneous tunnel and the catheter was connected to the reservoir with a connector. Conclusions: Although peritoneovenous shunt did not prolong the life expectancy of the patients with decompensated liver cirrhosis, it did relieve tense ascites rapidly and improve the quality of life remarkably. The modifications and salvaging procedures we used in our series could restore a dysfunctional Denver shunt easier, safer and with a higher cost-saving than a total revision of the shunt. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-0034935111&partnerID=40&md5=faf93647fd2a601834be23619283fe30 https://scholars.lib.ntu.edu.tw/handle/123456789/521536 |
ISSN: | 0172-6390 | SDG/關鍵字: | adolescent; adult; aged; article; ascites; clinical article; female; human; intravenous catheter; life expectancy; male; peritoneal catheter; peritoneum vein shunt; priority journal; salvage therapy; surgical technique; treatment outcome; Adolescent; Adult; Catheters, Indwelling; Cause of Death; Cross-Sectional Studies; Equipment Failure; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Peritoneovenous Shunt; Postoperative Complications; Reoperation; Salvage Therapy; Survival Rate |
顯示於: | 醫學系 |
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