单腔锁穿管引流法治疗肝硬化顽固性腹水的疗效观察

探讨肝硬化顽固性腹水的治疗方法。在支持利尿治疗的基础上,治疗组44例肝硬化顽固性腹水患者采用单腔锁穿管引流腹水法,对照组42例采用反复大量放腹水法。治疗组显效率77.27%,总有效率97.77%;对照组显效率57.14%,总有效率90.48%,治疗组与对照组比较腹水控制显效率(P<0.05)显著提高,疗程(P<0.05)明显缩短,继发循环功能紊乱(P<0.001)、低纳血症(P<0.05)明显减少。单腔锁穿管引流治疗肝硬化顽固性腹水的方法简便、安全,疗效满意,值得在临床上推广应用。     

腹水超滤浓缩回输腹腔治疗顽固性腹水

采用我所自行研制的Ｂ型腹水治疗仪 ,共治疗顽固性腹水 311例 ,现将资料完整者 92 1例次治疗结果报告如下 :一、材料与方法1.病例选择 :男 2 5 5例 ,女 5 6例 ,平均年龄 5 3 4岁 ,其中肝硬化 2 39例 ,慢性肾病 2 6例 ,其他 46例。均因顽固性腹水采用一般方法治疗无效而接受本治疗。2 .治疗前后观察项目 :(1)尿量 ;(2 )血液、腹水和滤出液的生化 ,以及部分患者腹水和滤出液的内毒素水平 ;(3)血液及滤出液的肾素、血管紧张素Ⅱ和醛固酮水平。3.疗效判断 :(1)显效 :腹水消失或仅存少量腹水 ,在利尿剂帮助下持续 3个月以上 ;(2 )有效 :腹水明显…     

超滤浓缩回输治疗肝硬化顽固性腹水156例临床研究

目的超滤浓缩回输治疗肝硬化腹水是临床治疗肝硬化顽固性腹水一大进展。方法甘肃省陇南市第一人民医院感染科自1998以来采用超滤浓缩回输治疗肝硬化顽固性腹水156例。结果显效93例,有效20例,无效43例,总有效率72.4%。与文献报道接近。结论其操作简易安全,疗效可靠,经济实用,适合基层医院推广使用。     

利用血液透析机进行腹水浓缩环注治疗肝硬化顽固性腹水114例疗效分析

目的探讨腹水浓缩环注治疗肝硬化顽固性腹水的疗效。方法利用血液透析装置对114例肝硬化顽固性腹水患者进行203次腹水浓缩环注(腹腔-腹腔)治疗,观察治疗前后症状、体征、尿量及血清白蛋白、肌酐、尿素氮、电解质的变化,并分析其疗效。结果114例患者共治疗203次,平均每次超滤腹水5560±2235毫升;治疗前腹胀者占98.03%(199/203),治疗结束后腹胀减少至4.93%(10/203,P<0.01)。治疗前呼吸困难占60.01%(122/203),治疗后减至0.99%(2/203,P<0.0l),每次治疗后尿量增至1500ml/日以上者占59.11%(121/203);治疗结束后血清总蛋白及白蛋白浓度有所增高,肌酐、尿素氮水平下降,电解质浓度无明显变化。治疗结束观察3个月时,显效率54.39%(62/114),有效率35.09%(40/114),总有效率89.48%(102/114)。结论利用血液透析机进行腹水浓缩环注治疗肝硬化顽固性腹水适应症广,副作用少,安全有效。     

自体腹水浓缩回输腹腔联合多巴胺治疗肝硬化顽固性腹水疗效观察

目的探讨自体腹水浓缩回输腹腔联合多巴胺在治疗肝硬化顽固性腹水中的应用价值。方法对51例肝硬化顽固性腹水患者在常规治疗基础上,加用自体腹水浓缩回输腹腔联合多巴胺治疗,评价其临床疗效及并发症。结果51例肝硬化顽固性腹水患者应用自体腹水浓缩回输腹腔联合多巴胺治疗,有效42例,总有效率达82．35％;对比单纯自体腹水浓缩回输腹腔治疗33例,有效23 例,总有效率69．70％,两组有效率差异有显著性,P<0．05。且两组治疗后内生肌酐清除率差异亦有显著性,P<0．05。结论自体腹水浓缩回输腹腔联合多巴胺治疗肝硬化顽固性腹水不仅见效快,且安全稳定,值得推广应用。     

中西医结合治疗肝硬化腹水(脾肾阳虚证)的临床研究

目的观察中西医结合治疗肝硬化腹水(脾肾阳虚证)的临床效果。方法共选择2014年1月~2016年4月我院收治的肝硬化腹水(脾肾阳虚证)患者88例,随机分为观察组44例和对照组44例,对照组给予西医常规治疗,观察组在对照组基础上再予中药济生消臌饮口服治疗,共治疗2周。结果经治疗后,观察组显效30例,有效12例,无效2例,总有效率95.45%;对照组显效16例,有效18例,无效10例,总有效率77.27%;观察组明显优于对照组(P0.05)。结论中西医结合治疗肝硬化腹水(脾肾阳虚证)效果满意,故值得推广。     

复方甘草酸苷联合普萘洛尔治疗肝硬化顽固性腹水的效果

目的评估复方甘草酸苷联合普萘洛尔治疗肝硬化顽固性腹水的价值。方法 118例肝硬化顽固性腹水患者分为治疗组(65例)和对照组(53例)。对照组采用常规腹水超滤浓缩回输、补充白蛋白、利尿和支持对症治疗。治疗组在对照组基础上加用复方甘草酸苷联合普萘洛尔。结果治疗组总有效率为86.15%,显著优于对照组62.26%(P<0.05)。治疗后,治疗组体重、腹围、周平均24 h尿量、谷丙转氨酶(ALT)、白蛋白(ALB)改善情况显著优于对照组(P<0.05),两组谷草转氨酶(AST)、总胆红素(TBIL)、凝血酶原活动度(PTA)、脾厚、门静脉内径比较无统计学意义(P>0.05)。结论复方甘草酸苷联合普萘洛尔在腹水超滤浓缩回输治疗顽固性腹水过程中临床疗效显著。     

腹水超滤浓缩回输腹腔术治疗肝硬化顽固性腹水疗效分析

目的 探讨腹水超滤浓缩回输腹腔术治疗肝硬化顽固性腹水的疗效。方法 将56例肝硬化顽固性腹水患者随机分为2组,均给予保肝、利尿及抗病毒治疗。在此基础上,对治疗组行腹水超滤浓缩回输腹腔术加小剂量人血白蛋白静脉滴注(静滴)(每滤出1000ml腹水,静滴人血白蛋白4g),对对照组行大量放腹水加大剂量人血白蛋白静滴(每抽出1000ml腹水,静滴人血白蛋白8g)。结果 术后第14天,治疗组患者24h尿量、血清ALB水平均高于对照组(P均<0.05),且治疗组总有效率高于对照组(P<0.05)。结论 腹水超滤浓缩回输腹腔术是一种安全有效的治疗肝硬化顽固性腹水的方法。     

中西医结合治疗肝硬化腹水42例

目的:观察中西医结合疗法治疗肝硬化腹水的临床疗效.方法:70例肝硬化腹水患者,随机分为治疗组42例,对照组28例.两组患者均采用西药常规治疗,治疗组患者另加服中药益气活血利水汤和软肝消瘢散,1个月为1个疗程,共治疗3个疗程.结果:治疗组显效率为54.8%(23例),有效率为38.1%(16例);对照组显效率为32.1%(9例),有效率为42.9%(12例).治疗组总有效率优于对照组.结论:中西医结合治疗肝硬化腹水的临床疗效优于单纯西医治疗方法.     

腹水超滤浓缩回输腹腔术对肝硬化顽固性大量腹水并发Ⅱ型肝肾综合征的疗效探讨

[目的]探讨腹水超滤浓缩回输腹腔术对肝硬化顽固性大量腹水患者并发Ⅱ型肝肾综合征的疗效。[方法]将66例肝硬化顽固性大量腹水同时并发Ⅱ型肝肾综合征的患者随机分为治疗组(34例)和对照组(32例);治疗组采用腹水超滤浓缩回输腹腔术治疗,对照组采用腹腔穿刺放液治疗。[结果]2组治疗后,在改善24h尿量、降低血清尿素氮、降低血清K+方面均较治疗前有效,但治疗组明显优于对照组(P0.05);2组不良反应发生率比较差异无统计学意义(P0.05)。[结论]合理应用腹水超滤浓缩回输腹腔术是一种治疗肝硬化顽固性大量腹水并发Ⅱ肝肾综合征的有效措施,可迅速改善患者肾脏功能,明显增加尿量,缓解氮质血症,解除高钾血症。     

Eosinophilic ascites

Summary Hypereosinophilic syndrome is a multisystem disease with progressive valvular dysfunction as a prominent feature. Ascites has not been recognized as a part of this syndrome. This paper presents a patient with hypereosinophilic syndrome who initially developed ascites and was recognized to have cardiac disease. The differential diagnosis of eosinophilic ascites is discussed.     

Myxedema ascites

Summary A 74-year-old man presented with mental obtundation and massive ascites without evidence of significant impairment of liver function. Thyroid function studies suggested hypothyroidism. Aspirated ascitic fluid had the characteristics of an exudate. Thyroid replacement therapy resulted in rapid clinical improvement with resolution of the ascites. Prompt recognition of myxedema ascites may prevent the inappropriate use of diuretic agents, therapeutic paracentesis, and sometimes unnecessary laparotomy.     

乳糜性腹水

乳糜性腹水是指乳状或奶油状的腹腔渗液 ,富含甘油三酯 ,是胸内和肠道淋巴液进入腹腔所致。乳糜性腹水临床发生率不高 ,国外[1,2 ] 的临床观察显示其大约占住院病例的两万分之一 (1∶2 0 0 0 0～ 1∶10 0 0 0 0 )。然而 ,由于进展性心肺疾患、腹部外科手术的增多和肿瘤患者的存活期延长 ,其发生率已经增加。北京协和医院[3 ] 乳糜性腹水近十年就检出 2 2例 ,远高于过去六十七年的 17例 ,当然这也可能和临床对它的认识提高有关。一、病理生理学乳糜性腹水形成和淋巴系统的破坏有关 ,主要是由于创伤性的损伤和阻塞引起。病因可能是良性或恶性…     

Chylous ascites

Summary The present study reports a patient with chylous ascites, edema, and hypoalbuminemia, which had appeared after pelvic surgery and irradiation for adenocarcinoma of the endocervix. The administration of a diet high in fat aggravated the degree of hypoalbuminemia and the extent of the edema. A reduction of the edema and of the ascites, and a rise in serum albumin to normal levels, followed the institution of a diet low in fat content. The dietary fat (LCT) was replaced isocalorically with MCT. Recurrence of the ascites, edema, and hypoalbuminemia occurred after a lymphangiogram, as the oily contrast medium transiently obstructed an already compromised lymphatic system.Supported in part by Grant AM-5156 from the NIH, US Public Health Service. The patient was studied at Yale Clinical Research Center, Grant FR-00125, US Public Health Service.     

Myelomatous ascites

Ascites is an unusual feature of multiple myeloma. We report a case of ascites occurring early in the course of a patient with myeloma in whom there was no evidence of intra-abdominal plasmacytoma, and the skeleton was relatively spared. The serum contained predominantly polymeric IgA, a feature not investigated in previous cases. We reviewed the relevant literature and will discuss the suggestion that human myelomas presenting with the triad of ascites, relative or absolute sparing of the skeleton, and an IgA paraprotein bear an analogy to mouse myelomas induced by intraperitoneal instillation of irritants. The relevance of polymeric IgA is discussed with respect to tissue origin of the paraprotein. Seventeen cases were identified consistent with a definition of "myelomatous ascites" (malignant myeloma in which plasma cells and/or monoclonal immunoglobulin can be demonstrated in ascitic fluid). IgA immunoglobulin class was present at three times the incidence seen in myelomas in general (five of seven cases were specified). In twelve patients there was no identifiable intra-abdominal plasmacytoma although liver infiltration was common. Amyloidosis was reported in only one case, and no cases of uncomplicated plasma cell leukemia were noted. Ascites was a presenting feature in five cases. In each of these five there was absolute or relative sparing of the skeleton, four had no evidence of plasmacytoma, and the paraprotein was IgA in three, IgG in one, and unreported in one. In no case was there a known history of chronic intra-abdominal irritation.     

Refractory ascites

Patients with cirrhosis have significant abnormalities in their fluid and electrolyte balance; this is manifested mainly by the development of ascites and edema. Ascites is the most common complication of patients with cirrhosis and its development constitutes the first and most important manifestation of the disease. With disease progression, patients with advanced cirrhosis and severe urinary sodium retention develop refractory ascites, a condition in which patients do not respond to diuretics or develop severe side effects to these that preclude their use. This condition occurs in 5-10% of cases admitted to the hospital for treatment of ascites. Approximately half of these patients will die within 1 year if not transplanted; therefore, the best therapy is liver transplantation in suitable candidates. During the last two decades, significant advances have been made in regard to pathogenesis and treatment of refractory ascites. The re-introduction of therapeutic paracentesis with plasma expansion in the 1980s was a milestone in the treatment of these patients. In addition, the introduction of transjugular intrahepatic portosystemic shunts as a therapy for refractory ascites has certainly provided a reasonable alternative for those patients with preserved liver function and unwilling to undergo several taps per month. This article will discuss the pathophysiology, clinical features and therapy of refractory ascites in cirrhosis.