目的:觀察持續腹腔引流治療頑固性腹水的療效。方法:將頑固性腹水患者74例分為兩組,治療組38例,采用腹腔置管,持續腹腔引流腹水,3000mL/天;對照組36例,以常規補充白蛋白、限鈉、限水、利尿治療為主,比較兩組的療效。觀察治療組治療前后患者尿量、腹圍和體重變化,并比較治療組與對照組在肝、腎功能及電解質的變化及總體療效。結果:治療組療效優于對照組(Plt;0.05),與治療前比較,治療組治療后尿量、腹圍、體重有明顯改變(Plt;0.01), 肝、腎功能及電解質與對照組比較無明顯變化(Pgt;0.05)。結論:持續腹腔引流治療頑固性腹水經濟適用,不良反應少,患者依從性好。
Objective To explore the methods and effect of venous retransfusion of ascites on the treatment of the complicated patients with Budd-Chiari syndrome.Methods Eighteen complicated and (or) recrudescent patients with Budd-Chiari syndrome were treated by venous retransfusion of ascites between March 2006 and July 2009. The changes in abdominal girth, body weight, the urine volume of 24 h, liver function, renal function, and serum electrolyte measurements before and after treatment were compared. Results After retransfusion of 5 000 ml to 7 800 ml (mean 6 940 ml) ascites, the abdominal girth of patients decreased (Plt;0.05), the urine volume of 24 h tended to normal and during which no serious side-effect happened. The levels of serum BUN, CREA, prothrombin time (PT), and activated partial thromboplastin time (APTT) decreased significantly (Plt;0.05), furthermore the levels of total albumen and albumin increased significantly (Plt;0.05). The changes of serum electrolyte measurements were not significant (Pgt;0.05). The follow-up period for all the patients was in the range of 4 to 37 months (mean 19 months). Then 12 patients were treated by the second operation at 3-6 months after discharge. Conclusions The ascites retransfusion provides a safe and effective treatment option for patients with refractory ascites, and yields a higher likelihood of discharge compared with conventional paracentesis. It is useful in improving quality of life and winning the operational chance for such as patients with complicated Budd-Chiari syndrome.
目的 探討肝硬化腹水患者不同血清鈉水平與病情嚴重程度的關系。 方法 回顧分析2008年7月－2010年6月收治47例肝硬化腹水并發低鈉血癥患者，根據其入院時血清鈉水平分為低鈉血癥輕（A組）、中（B組）、重（C組）3組。比較肝硬化腹水患者不同血鈉水平的腹水程度及療效的關系、以及低鈉程度與肝性腦病、肝腎綜合征和死亡發生率的關系。 結果 與A組比較，B、C兩組腹水量、肝性腦病、肝腎綜合征及病死率明顯增高，差異有統計學意義（P＜0.05）；對治療的效果明顯降低（P＜0.05）。 結論 肝硬化腹水患者的血清鈉水平與其病情程度具有緊密相關性，監測血清鈉的水平可作為判斷病情嚴重程度的重要指標之一，提示在臨床上需重視預防、及時發現并治療低鈉血癥。
ObjectiveTo understand the application progress of interventional therapy for chylous ascites (CA). MethodsThe domestic and foreign literature related to the diagnosis, imaging examination methods, and interventional treatment of CA in recent years were retrieved and summarized. ResultsThe sources of CA are diverse, the aetiology is different, and the treatment modalities will vary greatly, with the diagnosis of the source of lymphatic leakage being the basis for the effectiveness of interventional therapy. Through interventional treatment, such as intranodal lymphography, hepatic lymphogram, balloon occlusion retrograde abdominal lymphangiography, lymphatic leakage that is difficult to identify in traditional imaging examinations (CT, MRI, etc.) can be located and embolised to improve the diagnosis and treatment of CA. As an emerging means for the treatment of CA, interventional therapy has the advantages of less trauma, quick effect, and fewer complications. ConclusionsWith the continuous improvement of the interventional treatment approach, angiography, embolization materials, and the continuous accumulation of clinical experience, the interventional of CA will have more significant therapeutic effects and a broader application prospect.
【摘要】 目的 應用受試者工作特征曲線（receiver operating characteristic curve，ROC曲線）探討α-L-巖藻糖苷酶（AFU）對惡性腹水和非結核良性腹水的診斷價值。 方法 2004年7月—2008年1月對213例診斷明確的良、惡性腹水（其中良性腹水117例、惡性腹水96例）AFU活性進行檢測。采用ROC曲線評價AFU的診斷靈敏度、特異度、準確性、陽性預測值、陰性預測值、陽性似然比、陰性似然比及Youden指數，評價其診斷效率。 結果 惡性腹水組AFU水平（164.96±87.72） μmol/（L?h），良性腹水組（104.02±62.07） μmol/（L?h），兩者比較差異有統計學意義（Plt;0.01）。AFU診斷惡性腹水的ROC 曲線下面積為0.754±0.034，最佳分界值101.95 μmol/（L?h）。以AFU≥101.95 μmol/（L?h）來預測惡性腹水，其診斷的靈敏度為82.3%，特異度為63.2%，準確性為72.8%、陽性預測值為65.3%、陰性預測值為83.1%、陽性似然比為2.23、陰性似然比為0.28及Youden指數為0.455。 結論 腹水AFU活性檢測有助于惡性腹水和非結核良性腹水的鑒別診斷，是一個比較理想的實用指標，適合于基層醫院的臨床應用。【Abstract】 Objective To assess the value of α-L-fucosidase (AFU) levels with receiver operating characteristic curve (ROC curve) in the diagnosis of malignant and non-tuberculous benign ascites. Methods Ascitic AFU activity was measured in 213 patients (117 with benign ascites and 96 with malignant ascites) diagnosed with benign or malignant ascites. The diagnostic sensitivity (SEN), specificity (SPE), accuracy, positive predictive value (PV+), negative predictive value (PV-), positive likelihood ratio (LR+), negative likelihood ratio (LR-) and Youden index (YI) of AFU were assessed with receiver operating characteristic curve, and the diagnostic effectiveness of AFU was evaluated. Results The average level of AFU in the malignant group [(164.96±87.72) μmol/(L?h)] was significantly higher than that in the benign group [(104.02±62.07) μmol/(L?h)] (Plt;0.01). The area under the curve (AUC) of the ROC curve of AFU was 0.754±0.034 for malignant ascites diagnosis, and the optimal cut-off value was 101.95 μmol/(L?h). When an AFU level equal to or higher than 101.95 μmol/(L?h) was used to predict malignant ascites, the diagnostic sensitivity was 82.3%, specificity was 63.2%, accuracy was 72.8%, PV+ was 65.3%, PV- was 83.1%, LR+ was 2.23, LR- was 0.28 and YI was 0.455. Conclusion Detection of AFU activity in ascites is helpful to differentiate the diagnose between malignant and non-tuberculous benign ascites, which is a relatively ideal index to fit for clinical application of local hospitals.
Objective To study the effect and intrinsic mechanism of acute suppurative peritonitis associated ascitic fluid (ASPAAF) on experimental liver injury of rats. Methods Thirty-two male or female Sprague-Dawley (SD) rats were randomly divided into two groups: ASPAAF group (n=16) and control group (n=16), in which 8 ml ASPAAF or normal saline (NS) were injected into the peritoneal cavity, respectively. The rats were killed at each time intervals after peritoneal cavity injection (6 h and 12 h) respectively in two groups and specimens were made to detect the levels of serum TNF-α, endotoxin and liver function (AST, ALT and STB). The level of TNF-α in liver tissues was measured. The pathological change of liver was observed by microscope. Results The levels of TNF-α, endotoxin, ALT, AST and STB in serum and the levels of TNF-α in liver tissues at different time points were markedly higher in ASPAAF group compared with those in control group (P＜0.05), and these indexes increased with increasing time in ASPAAF group (P＜0.05). In ASPAAF group, hepatic tissue appeared hydrops, even spotty necrosis and the changes at 6 h and 12 h were not obvious different. No abnormal pathological change of hepatic tissue was found in control group. Conclusion ASPAAF can induce the injury of the liver in rats, which may involved in TNF-α and endotoxin.
Objective To systematically review the effectiveness and safety of hyperthermia (HT) plus intraperitoneal hyperthermic perfusion chemotherapy (IHPC) versus IHPC alone for malignant ascites. Methods Such databases as PubMed, The Cochrane Library, EMbase, VIP, WanFang, CNKI and CBM were electronically and comprehensively searched for randomized controlled trials (RCTs) on HT plus IHPC vs. IHPC alone for malignant ascites from inception to March 2013. Two reviewers independently screened studies according to inclusion and exclusion criteria, extracted data and assessed quality of the included studies. References of the included studies were also retrieved. Then, meta-analysis was performed using RevMan 5.1 software. Results A total of 16 RCTs involving 984 patients were included. The results of meta-analysis showed that, compared with the IHPC alone group, the HT plus IHPC group had a higher effective rate of controlling ascites (OR=3.40, 95%CI 2.58 to 4.48, Plt;0.000 01), better improvement in quality of life (OR=2.77, 95%CI 1.90 to 4.05, Plt;0.000 01), with significant differences. The two groups were alike in 1-year survival with no significant difference (OR=1.80, 95%CI 0.61 to 5.31, P=0.28). As for safety, there was no significant difference between the two groups in the incidences of nausea and vomiting, abdominal distension and pain, myelosuppression, diarrhea, and constipation. Conclusion The results of this systematic review show that, compared with IHPC alone, HT plus IHPC improves the effective rate as well as the quality of life of patients with malignant ascites, and it does not increase the incidences of adverse reactions. Due to the limited quality and quantity of the included studies, more high quality RCTs with larger sample size are needed to verify the above conclusion.
目的:為了探討肝硬化放腹水后應用右旋糖酐40代替人血白蛋白治療頑固性腹水的臨床療效及其經濟性。方法:將216例肝硬化頑固性腹水患者隨機分為A,B,C三組。A組:定期放腹水后應用右旋糖酐40;B組:定期放腹水后應用人血白蛋白或血漿;C組:傳統治療方法,限鈉和不斷增加利尿劑用量。結果:A組分別與B組,C組相比較,其腹水消退時間,ALT復常率,輸血不良反應,住院費用,平均住院日,好轉治愈率,死亡率,以上各項對比均有顯著性差異(Plt;0.05)。血清蛋白量的對比無顯著性差異(Pgt;0.05)。結論:肝硬化放腹水后應用右旋糖酐40治療頑固性腹水,能縮短病程,減少住院日,降低醫療費用,降低死亡率。