血液透析同步腹水回输治疗尿毒症并顽固性腹水1例

对l例尿毒症并顽固性腹水病人，在血液透析(HD)治疗时，同步进行密闭自体腹水回输。并严密观察腹水回输前后的症状、体征，血生化指标的变化及并发症发生情况。结果 病人经5次腹水回输疗效显著，体重减轻4．8kg，腹围减少9．6cm。提示应用HD同步密闭自体腹水回输，可提高尿毒症并顽固性腹水病人治疗效果。     

Ascites after liver transplantation

Massive ascites after liver transplantation, although uncommon, usually represents a serious adverse event. The pathogenesis of this complication has not been adequately investigated. To determine the incidence, characteristics, and pathogenic factors of massive ascites after liver transplantation (ascitic fluid > 500 mL/d for > 10 days), the charts of 378 liver transplant recipients were reviewed. Massive ascites occurred in 25 patients (7%). Mean ascitic fluid production was 960 mL/d (range, 625 to 2,350 mL/d), and the duration of ascites was 77 days (range, 15 to 223 days). The ascitic fluid had a high protein content (36 ± 7 g/L; range, 25 to 50 g/L). When patients who did and did not develop massive ascites were compared, significant differences were found in receptor sex (men, 88% v 60%, respectively; P < .01) and surgical technique (inferior vena cava preservation with piggyback technique, 72% v 41%; P < .01). Significantly increased wedged and free hepatic venous pressures and gradients between hepatic vein and right atrial pressures were found in patients who developed ascites, suggesting a difficulty in graft blood outflow. Massive ascites was associated with renal impairment, increased incidence of abdominal infection, prolonged hospitalization, and a tendency toward reduced survival. In conclusion, massive ascites after liver transplantation is relatively uncommon but associated with increased morbidity and mortality and is predominantly related to difficulties of hepatic venous drainage. Measurement of hepatic vein and atrial pressures to detect a significant gradient and correct possible alterations in hepatic vein outflow should be the first approach in the management of these patients.     

Peritoneo-Venous Shunting for Ascites

A new minor surgical procedure for ascites has been devised wherein a specially designated one way pressure activated valve is implanted to create a permanent peritoneo-venous shunt. The normally closed valves opens only when the peritoneal pressure rises 3-5 cm higher than the intrathoracic venous pressure thus preventing backflow of blood and closing the valve should the venous pressure rise from the over-infusion of ascitic fluid. The procedure has been performed on 45 patients but nine were terminal at the time of surgery. Prolonged relief of ascites occurred in 28 of 37 cases.     

Ascites in newborn infants

Neonatal ascites is reviewed, and a case due to posterior urethral valves is presented. Treatment was, for the most part, conservative in contrast to aggressive surgical intervention which is taught and advocated. The result was satisfactory.     

腹水浓缩光量子照射回输治疗顽固性腹水98例

将130例肝硬化顽固性腹水病人分为观察组(98例)和对照组(32例)。对照组采用常规护肝、利尿及支持等治疗，观察组在常规治疗的基础上对腹水应用腹水超滤浓缩机光量子治疗仅照射后经腹腔回输治疗。系统治疗8周，随访12周后比较两组疗效。结果ALT、AST、白蛋白(A)、PT的改善观察组优于对照组(均P＜0．05)；治疗有效率观察组为89．8％，对照组为56．3％，两组比较，差异有极显著性意义(P＜0．01)。应用该疗法过程中未发生严重并发症。提示该治疗方法可有效减少肝硬化顽固性腹水病人的腹水量，改善肝功能，且安全性好。     

腹水超滤浓缩回输腹腔治疗肝硬化难治性腹水的护理

对 35例肝硬化难治性腹水病人采用腹水超滤浓缩经腹腔回输治疗和针对性护理。结果治疗后病人体重、2 4h尿量、尿钠及血清白蛋白等显著增加 (均P <0 .0 1) ,治疗有效率 71.4 2 %。提示本治疗和护理方法能有效促进腹水吸收 ,利于原发病的治疗。     

Ascites after liver transplantation--a mystery.

Ascites after liver transplantation, although uncommon, presents a serious clinical dilemma. The hemodynamic changes that support the development of ascites before liver transplantation are resolved after transplant; therefore, persistent ascites (PA) after liver transplantation is unexpected and poorly characterized. The aim of this study was to define the clinical factors associated with PA after liver transplantation. This was a retrospective case-control analysis of patients who underwent liver transplantation at the University of Pennsylvania. PA occurring for more than 3 months after liver transplantation was confirmed by imaging studies. PA was correlated with multiple recipient and donor variables, including etiology of liver disease, preoperative ascites, prior portosystemic shunt (PS), donor age, and cold ischemic (CI) time. There were 2 groups: group 1, cases with PA transplanted from November 1990 to July 2001, and group 2, consecutive, control subjects who underwent liver transplantation between September 1999 and December 2001. Both groups were followed to censoring, May 2002, or death. Twenty-five from group 1 had ascites after liver transplantation after a median follow-up of 2.6 years. In group 1 vs group 2 (n = 106), there was a male predominance 80% vs 61% (P =.10) with similar age 52 years; chronic hepatitis C virus (HCV) was diagnosed in 88% vs 44% (P <.0001); preoperative ascites and ascites refractory to treatment were more prevalent in group 1 (P =.0004 and P =.02, respectively), and CI was higher in group 1, (8.5 hours vs 6.3 hours, P =.002). Eight of the 25 (group 1) had portal hypertension with median portosystemic gradient 16.5 mm Hg (range, 16-24). PS was performed in 7 of 25 cases, which resulted in partial resolution of ascites. The development of PA after liver transplantation is multifactorial; HCV, refractory ascites before liver transplantation, and prolonged CI contribute to PA after liver transplantation.