Clinical Experience with the Peritoneovenous Shunt for Intractable Ascites

Abstract

We retrospectively reviewed the medical records of 19 patients with decompensated liver cirrhosis and intractable ascites who underwent placement of a peritoneovenous shunt from July l993 through January 1998, at Chang Gung Memorial Hospital, Linkou Taiwan. There were eight men and 11 women, with a mean age of 58.2 years (range, 43 to 76 years). Nine patients had Child-Pugh B and 10 had Child-Pugh C stage liver disease. The duration of shunt patency ranged from 4 to 210 days, with an average of 76.8 days． These 19 patients experienced a total of 41 postoperative comlications; the events included spontaneous bacterial peritonitis (9 cases), esophageal variceal bleeding (8), shunt infection (6), pleural effusion (4), pneumonia (3), central venous pressure (CVP) catheter infection (3), shunt occlusion (3), hepatic encepalopathy (3), wound infection (1), and ascites leakage (1). Escherichia coli and Staphylococcus aureus were responsible for most cases of infection. The survival rates were 78.9% (15/19) at 1 month, 31.6% (6/19) at 6 months, and 5.3% (1/19) at 1 year. In conclusion, the peritoneovenous shunt was effective in relieving intractable ascites and increasing urine output．However, shunt complications were common and the survival rate did not improved．Physicians should be very careful in selecting patients to receive peritoneovenous shunts.