摘要:

&NA;The peritoneovenous shunt (PVS) is a safe procedure; all of its complications have been found to be preventable. Disseminated intravascular coagulopathy (DIC) can be a life threatening complication but has been completely eliminated by draining the ascitic fluid at the time of surgery, as it is caused by the introduction of excessive quantities of peritoneal fluid into the venous system. Peritoneal fluid is rich in tissue plasminogen activator (TPA), which is inhibited by epsilon aminocaproic acid. This substance has been successfully used to treat postshunt coagulopathy. The salt retention associated with ascites is related to a diminished plasma volume, a condition further aggravated by diuretic drugs. A PVS should be inserted if the patient does not respond to a salt restricted diet. Occult peritonitis occurs in 10≥ of cirrhotic ascites. The shunt does not prevent this, and a high percentage of late shunt failures are caused by fibrinopurulent debris in the valve. The valve system should not contain a pump, which disseminates infection and causes fatal emboli; pumping and flushing are seldom remedial and often dangerous. Because the complications of the shunt are all preventable, the indications for the shunt should be liberalized.ASAIO Transactions1989; 35:165–168.

ISSN:1058-2916    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:1058-2916    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;To test the hypothesis that prolonged freedom from clinically detectable ascites after peritoneovenous shunt insertion is the result of continued drainage of ascitic fluid through the shunt, the authors studied shunt patency and function in 26 of the 27 survivors of 59 alcoholic cirrhotic patients operated upon 2–6 years previously for massive ascites resistant to medical therapy. Twenty‐three patients were without clinically detectable ascites (minimal ascites—Group A), and three had large ascites (Group B). In 20 Group A patients the shunts were patent and functioning. The other three Group A patients had completely occluded shunts without demonstrable ascitic fluid flow. In one Group B patient with a daily fluid intake of 5–6 L, the shunt was partially obstructed but flow was rapid; in the other two, shunts were completely occluded. One subject in Group B with a completely obstructed shunt was resistant to medical treatment after 6 years of freedom from ascites, whereas the other two were controlled medically. In the three in Group A who had nonfunctioning shunts and required no diuretics, the severity of the ascites had decreased so that artificial drainage was no longer necessary. Thus, freedom from clinically significant ascites does not always indicate that the shunt continues to function.ASAIO Transactions1989; 35: 170–174.

ISSN:1058-2916    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:1058-2916    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:1058-2916    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:1058-2916    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:1058-2916    

出版商:OVID    

年代:1989

数据来源: OVID