中西医结合治疗肝硬化腹水27例

目的 观察中西医结合治疗肝硬化腹水的临床疗效.方法 随机将患者分为治疗组27例和对照组25例,治疗组采用中西医结合治疗,对照组采用西医常规治疗.结果 治疗组的总有效率为96.3%,显著优于对照组的72%(P＜0.05).结论 中西医结合治疗肝硬化腹水有良好效果.     

Percutaneous peritoneovenous shunt positioning: technique and preliminary results

Nine peritoneovenous shunts were positioned by percutaneous technique in seven patients with advanced malignancy causing severe refractory ascites, and in two patients with hepatic cirrhosis (one with hepatocarcinoma). In all patients the shunts were percutaneously placed through the subclavian vein in the angiographic suite under digital fluoroscopic guide. No complications directly related to the procedure occurred. The shunt was successfully positioned in all patients in 60 min average time. No patient showed symptoms related to pulmonary overload or to disseminated intravascular coagulation. All patients had a significant improvement of the objective symptoms related to ascites such as respiratory symptoms, dyspepsia, and functional impairment to evacuation describing an improvement of their quality of life. Maximum shunt patency was 273 days. Percutaneous placement of peritoneovenous shunt is a safe, fast, and inexpensive procedure, extremely useful in resolution of refractory ascites, reducing symptoms, and allowing effective palliation, with a great improvement in quality of life.     

血清CA125水平与肝硬化Child-pugh分级及腹水量的关系

目的探讨肝硬化患者血清肿瘤抗原125(CA125)水平与肝功能Child-pugh分级及腹水量的关系.方法肝硬化患者91例,Child-pugh A级32例,B级36例,C级23例;腹水阳性者50例,腹水阴性者41例;正常对照32例.均采用ELISA法检测血清CA125水平.结果肝硬化患者血清CA125水平显著高于对照组(P＜0.01),肝硬化患者血清CA125水平Child-pugh C级＞B级＞A级,随着肝损害程度加重而进行性升高(P＜0.01);肝硬化腹水组及少量腹水组血清CA125水平均显著高于肝硬化无腹水组(P＜0.01),中量腹水组血清CA125水平显著高于少量腹水组(P＜0.01),大量腹水组与中量腹水组的血清CA125水平比无统计学意义.结论肝硬化患者血清CA125水平与肝功能损害及腹水程度密切相关,可以被认为是反映肝硬化程度及监测腹水情况的一项敏感指标,对肝硬化腹水的早期诊断及估计预后具有较高的参考价值.     

脱落细胞端粒酶活性检测在肿瘤鉴别的价值

目的检测胸腹水、脑脊液（CSF）脱落细胞端粒酶活性，探讨端粒酶对良、恶性肿瘤鉴别诊断的应用价值。方法以TRAP—PCR法对胸腹水和脑脊液脱落细胞进行端粒酶活性的检测。结果肝硬化、结核性腹膜炎胸腹水及脑积水脑脊液脱落细胞一般不能检出端粒酶活性，而癌性胸腹水或恶性脑膜瘸端粒酶阳性率为86．9％，显著高于细胞学检查的阳性率（69．5％）。细胞学阳性的标本端粒酶活性均为阳性。结论端粒酶活性的检测敏感性较高，对体液良、恶性肿瘤有重要的鉴别诊断价值。     

阿佐塞米治疗心、肝、肾等疾患引起的水肿或腹水的临床疗效和安全性

目的:研究髓袢利尿剂阿佐塞米治疗心、肝、肾等疾患引起水肿或腹水的临床疗效和安全性.方法:采用随机、盲法、多中心、呋塞米对照方法,将223例符合入选标准的患者(心性水肿92例、肝性水肿63例、肾性水肿68例)随机分入阿佐塞米组和呋塞米组,心性和肾性水肿患者每日一次口服阿佐塞米30 mg或呋塞米20 mg,肝性腹水患者每日一次口服阿佐塞米60 mg或呋塞米40 mg.3日末如利尿未达有效者药物剂量增加,心性和肾性水肿患者至阿佐塞米60 mg或呋塞米40 mg,肝性腹水患者阿佐塞米每日90 mg或呋塞米每日60 mg,直至2周末.结果:2周末,阿佐塞米、呋塞米组体重均较治疗前显著下降,体重下降(2.87±3.10)kg和(2.81±2.84)kg;消肿有效率为89.19%和89.81%;纠正心功能不全有效率为64.44%和66.66%;24 h尿量增加(321.85±669.52)ml和(273.80±645.72)ml;B超测定治疗腹水有效率为89.28%和86.66%;腹围减少(5.20±3.58)cm和(5.03±3.74)cm.两组间比较无统计学差异(P>0.05).两组不良反应发生率分别为23.01%和21.01%,主要表现为低血钾、血尿酸升高、甘油三酯升高、口干和ALT升高等.结论:阿佐塞米片30～90 mg每日一次口服治疗2周,疗效及安全性与20～60 mg呋塞米片一致;对心、肝、肾性水肿或腹水有显著的消肿利尿、改善心功能、减少腹水的作用,是一种有效、耐受性良好的治疗药物.     

Expression of Vascular Endothelial Growth Factor and E-Cadherin in Human Ovarian Cancer: Association with Ascites Fluid Accumulation and Peritoneal Dissemination in Mouse Ascites Model

Ascites formation and peritoneal dissemination are critical problems in patients with advanced ovarian cancer. Vascular endothelial growth factor (VEGF), also known as angiogenic growth factor, is a potent mediator of peritoneal fluid accumulation and angiogenesis of tumors. E-Cadherin is an adhesion molecule that is important for cell-to-cell interaction. To elucidate the molecular mechanism of ascites formation and peritoneal dissemination of ovarian cancer, we examined the expression of VEGF and E-cadherin in different ovarian cancer cell lines and utilized nude mice to compare the biological characteristics of ovarian cancer cells. Three human ovarian cancer cell lines (AMOC-2, HNOA and HTBOA) were used in this study. Expression of genes was analyzed by northern blotting and RT-PCR methods. AMOC-2 expressed E-cadherin, but not VEGF. HNOA expressed VEGF without E-cadherin expression. HTBOA expressed both VEGF and E-cadherin. Each human ovarian cancer model revealed a specific feature. The AMOC-2 mouse had a single large peritoneal tumor without ascites or remarkable peritoneal dissemination. HTBOA and HNOA mice had bloody ascites and marked peritoneal dissemination. Introduction of VEGF antisense into HTBOA cells could inhibit the ascites formation. It is suggested that VEGF is important for the ascites formation via the increased vascular permeability effect. The deregulation of E-cadherin expression might be involved in the peritoneal dissemination. These molecules are important for the formation of specific features of advanced ovarian cancer. Ovarian cancer cell lines that had different gene expression patterns produced nude mouse human ovarian cancer models with different characteristics.     

微机用于消化性疾病诊断与治疗

本文叙述用IBM PC/XT及其兼容机对腹痛、腹水、黄疸、上消化道出血、腹泻5大症状的25种疾病进行监别诊断和治疗。它是在输入专家经验的基础上,对患者症状、体征、辅助检查等项结果采用菜单式选项,即可得出包括患者主诉、诊断、诊断依据、治疗用药及处置等内容完整的病历卡。用本系统对已确诊的腹水病人100例及疑难腹水病人31例进行验证,符合率分别为100％及96％。     

Spontaneous ruptured umbilical hernia in a child with hepatic cirrhosis and ascites

Spontaneous rupture of umbilical hernia is an unusual and rarely reported complication in the patient with hepatic cirrhosis and ascites, and it may be fatal. A literature search revealed that patients have been managed both operatively and nonoperatively for this condition. All of the reported cases in the literature were adults with liver disease and ascites. We present a first case of spontaneous rupture of an umbilical hernia in a child with cirrhosis and ascites, which was managed with primary repair of the hernia.     

A complex caliceal-cutaneous and caliceal-peritoneal fistula in a renal transplant patient: a case for conservative management

Caliceal fistula is a rare complication after renal transplant and may lead to graft failure. We present a case of complex caliceal-cutaneous and caliceal-peritoneal fistula in a renal transplant patient who was successfully managed conservatively.     

Acute abdominal attack of hereditary angioneurotic oedema associated with ultrasound abnormalities suggestive of acute hepatitis

Hereditary angioneurotic oedema (HANO) is an autosomal dominant disorder caused by a deficiency of the inhibitor protein Cl-esterase. Recurrent subcutaneous and/or submucosal oedema formation is a hallmark of this disease. HANO is a rare, but potentially life-threatening disorder with a mortality around 20-30%. Acute oedematous abdominal attacks of HANO can mimic a surgical emergency; this is exemplified by the case of a 14-y-old male patient with HANO admitted for such clinical manifestations. Conclusion: Diagnostic clues include ascites and abnormalities of hepatic structure visible with ultrasound during the oedematous attack. The importance of appropriate treatment is emphasized.