李震 1 , 汪忠鎬 1,2 , 霍小森 1 , 王雷永 1 , 季鋒 1 , 卞策 3
  • 1.中國(guó)航空工業(yè)中心醫(yī)院血管外科(北京 100012);;
  • 2.首都醫(yī)科大學(xué)宣武醫(yī)院血管外科(北京 100053);;
  • 3.第二炮兵總醫(yī)院心胸血管外科(北京 100088);

目的 探討腹水靜脈回輸在重癥布加綜合征治療中的方法及意義。
方法 2006年3月至2009年7月期間在第二炮兵總醫(yī)院對(duì)18例重癥或復(fù)發(fā)的布加綜合征患者給予腹水靜脈回輸治療，對(duì)治療前、后患者一般情況、肝腎功能、凝血功能和電解質(zhì)檢測(cè)結(jié)果以及療效進(jìn)行分析。
結(jié)果 腹水回輸量5 000～7 800 ml，平均6 940 ml，患者腹水回輸過程中無明顯并發(fā)癥發(fā)生。與治療前比較，患者腹圍明顯減小(P lt;0.05)，體重?zé)o明顯變化，24 h尿量有增多趨勢(shì)(P gt;0.05)?；颊咧委熀笱蹇偟鞍?、白蛋白明顯提高(P lt;0.05)，尿素氮及肌酐明顯下降(P lt;0.05)，患者肝、腎功能均獲不同程度好轉(zhuǎn)。血漿凝血酶原時(shí)間（PT）和活化的部分凝血活酶時(shí)間（APTT）明顯縮短(P lt;0.05)，血清電解質(zhì)無明顯變化(P gt;0.05)。治療后所有患者隨訪4～37個(gè)月，平均19個(gè)月。其中12例在治療3～6個(gè)月后，因可以耐受手術(shù)而再次手術(shù)治療。
結(jié)論 腹水靜脈回輸對(duì)重癥布加綜合征是一種安全、有效的治療方法，可以明顯改善患者的生活質(zhì)量，為后續(xù)治療贏得了機(jī)會(huì)。

引用本文： 李震,汪忠鎬,霍小森,王雷永,季鋒,卞策. 腹水靜脈回輸在重癥布加綜合征治療中的作用. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(8): 828-831下轉(zhuǎn)836. doi: 復(fù)制

版權(quán)信息： ?四川大學(xué)華西醫(yī)院華西期刊社《中國(guó)普外基礎(chǔ)與臨床雜志》版權(quán)所有，未經(jīng)授權(quán)不得轉(zhuǎn)載、改編

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2. Li CM, Wang ZG, Gu YQ, et al. Management of complex patients with BuddChiari syndrome [J]. Ann Vasc Surg, 2010; 24(3): 301307.
3. Senousy BE, Draganov PV. Evaluation and management of patients with refractory ascites [J]. World J Gastroenterol, 2009; 15(1): 6780.
4. Kuiper JJ, de Man RA, van Buuren HR. Review article: Management of ascites and associated complications in patients with cirrhosis [J]. Aliment Pharmacol Ther, 2007; 26 Suppl 2: 183193.
5. 李震, 汪忠鎬, 卞策, 等. 腸房轉(zhuǎn)流通暢前提下并發(fā)頑固性腹水的治療 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(7): 571572.
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7. Hou W, Sanyal AJ. Ascites: diagnosis and management [J]. Med Clin North Am, 2009; 93(4): 801817.
8. Kashani A, Landaverde C, Medici V, et al. Fluid retention in cirrhosis: pathophysiology and management [J]. QJM, 2008; 101(2): 7185.
9. 嚴(yán)律南, 李波, 曾勇, 等. 活體肝移植治療布加綜合征并下腔靜脈狹窄 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2006; 13(1): 8284, 88.
10. Kiafar C, Gilani N. Hepatic hydrothorax: current concepts of pathophysiology and treatment options [J]. Ann Hepatol, 2008; 7(4): 313320.
11. Saadeh S, Davis GL. Management of ascites in patients with endstage liver disease [J]. Rev Gastroenterol Disord, 2004; 4(4): 175185.
12. Bhattacharya A, Mittal BR, Biswsa T, et al. Radioisotope scintigraphy in the diagnosis of hepatic hydrothorax [J]. J Gastroenterol Hepatol, 2001; 16(3): 317321.
13. 汪忠鎬, 李震. 我國(guó)血管外科的現(xiàn)狀和發(fā)展 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2006; 13(6): 625628.
14. Wang ZG, Zhang FJ, Li XJ, et al. Management of BuddChiari syndrome: what is the best approach? [J]. J Gastroenterol Hepatol, 2004; 19 (S7): S212S218.
15. Wang ZG, Jone RS. BuddChiari syndrome [J]. Curr Probl Surg, 1996; 33(2): 83211.
16. Slakey DP, Klein AS, Venbrux AC, et al. BuddChiari Syndrome: current management options [J]. Ann Surg, 2001; 233(4): 522527.
17. Cheruvattath R, Balan V. Infections in patients with endstage liver disease [J]. J Clin Gastroenterol, 2007; 41(4): 403411.
18. Lee JM, Han KH, Ahn SH. Ascites and spontaneous bacterial peritonitis: an Asian perspective [J]. J Gastroenterol Hepatol, 2009; 24(9): 14941503.
19. Mller S, Henriksen JH, Bendtsen F. Pathogenetic background for treatment of ascites and hepatorenal syndrome [J]. Hepatol Int, 2008; 2(4): 416428.
20. Tomiyama K, Takahashi M, Fujii T, et al. Improved quality of life for malignant ascites patients by Denver peritoneovenous shunts [J]. Anticancer Res, 2006; 26(3B): 23932395.
21. Kawamoto J, Kimura F, Shimizu H, et al. Successful treatment for intractable ascites with uterine cancer using double Denver peritoneovenous shunt system [J]. Gan To Kagaku Ryoho, 2006; 33(12): 19191923.
22. Won JY, Choi SY, Ko HK, et al. Percutaneous peritoneovenous shunt for treatment of refractory ascites [J]. J Vasc Interv Radiol, 2008; 19(12): 17171722.
23. Seike M, Maetani I, Sakai Y. Treatment of malignant ascites in patients with advanced cancer: peritoneovenous shunt versus paracentesis [J]. J Gastroenterol Hepatol, 2007; 22(12): 21612166.
24. Oida T, Mimatsu K, Kawasaki A, et al. Implantation of a Denver shunt by left subclavian approach for preventing kinking [J]. Hepatogastroenterology, 2009; 56(93): 10741077.
25. Rosemurgy AS, Zervos EE, Clark WC, et al. TIPS versus peritoneovenous shunt in the treatment of medically intractable ascites: a prospective randomized trial [J]. Ann Surg, 2004; 239(6): 883889.
  1. 1. Ginès P, Cárdenas A, Arroyo V, et al. Management of cirrhosis and ascites [J]. N Engl J Med, 2004; 350(16): 16461654.
  2. 2. Li CM, Wang ZG, Gu YQ, et al. Management of complex patients with BuddChiari syndrome [J]. Ann Vasc Surg, 2010; 24(3): 301307.
  3. 3. Senousy BE, Draganov PV. Evaluation and management of patients with refractory ascites [J]. World J Gastroenterol, 2009; 15(1): 6780.
  4. 4. Kuiper JJ, de Man RA, van Buuren HR. Review article: Management of ascites and associated complications in patients with cirrhosis [J]. Aliment Pharmacol Ther, 2007; 26 Suppl 2: 183193.
  5. 5. 李震, 汪忠鎬, 卞策, 等. 腸房轉(zhuǎn)流通暢前提下并發(fā)頑固性腹水的治療 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(7): 571572.
  6. 6. Mller S, Henriksen JH, Bendtsen F. Ascites: pathogenesis and therapeutic principles [J]. Scand J Gastroenterol, 2009; 44(8): 902911.
  7. 7. Hou W, Sanyal AJ. Ascites: diagnosis and management [J]. Med Clin North Am, 2009; 93(4): 801817.
  8. 8. Kashani A, Landaverde C, Medici V, et al. Fluid retention in cirrhosis: pathophysiology and management [J]. QJM, 2008; 101(2): 7185.
  9. 9. 嚴(yán)律南, 李波, 曾勇, 等. 活體肝移植治療布加綜合征并下腔靜脈狹窄 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2006; 13(1): 8284, 88.
  10. 10. Kiafar C, Gilani N. Hepatic hydrothorax: current concepts of pathophysiology and treatment options [J]. Ann Hepatol, 2008; 7(4): 313320.
  11. 11. Saadeh S, Davis GL. Management of ascites in patients with endstage liver disease [J]. Rev Gastroenterol Disord, 2004; 4(4): 175185.
  12. 12. Bhattacharya A, Mittal BR, Biswsa T, et al. Radioisotope scintigraphy in the diagnosis of hepatic hydrothorax [J]. J Gastroenterol Hepatol, 2001; 16(3): 317321.
  13. 13. 汪忠鎬, 李震. 我國(guó)血管外科的現(xiàn)狀和發(fā)展 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2006; 13(6): 625628.
  14. 14. Wang ZG, Zhang FJ, Li XJ, et al. Management of BuddChiari syndrome: what is the best approach? [J]. J Gastroenterol Hepatol, 2004; 19 (S7): S212S218.
  15. 15. Wang ZG, Jone RS. BuddChiari syndrome [J]. Curr Probl Surg, 1996; 33(2): 83211.
  16. 16. Slakey DP, Klein AS, Venbrux AC, et al. BuddChiari Syndrome: current management options [J]. Ann Surg, 2001; 233(4): 522527.
  17. 17. Cheruvattath R, Balan V. Infections in patients with endstage liver disease [J]. J Clin Gastroenterol, 2007; 41(4): 403411.
  18. 18. Lee JM, Han KH, Ahn SH. Ascites and spontaneous bacterial peritonitis: an Asian perspective [J]. J Gastroenterol Hepatol, 2009; 24(9): 14941503.
  19. 19. Mller S, Henriksen JH, Bendtsen F. Pathogenetic background for treatment of ascites and hepatorenal syndrome [J]. Hepatol Int, 2008; 2(4): 416428.
  20. 20. Tomiyama K, Takahashi M, Fujii T, et al. Improved quality of life for malignant ascites patients by Denver peritoneovenous shunts [J]. Anticancer Res, 2006; 26(3B): 23932395.
  21. 21. Kawamoto J, Kimura F, Shimizu H, et al. Successful treatment for intractable ascites with uterine cancer using double Denver peritoneovenous shunt system [J]. Gan To Kagaku Ryoho, 2006; 33(12): 19191923.
  22. 22. Won JY, Choi SY, Ko HK, et al. Percutaneous peritoneovenous shunt for treatment of refractory ascites [J]. J Vasc Interv Radiol, 2008; 19(12): 17171722.
  23. 23. Seike M, Maetani I, Sakai Y. Treatment of malignant ascites in patients with advanced cancer: peritoneovenous shunt versus paracentesis [J]. J Gastroenterol Hepatol, 2007; 22(12): 21612166.
  24. 24. Oida T, Mimatsu K, Kawasaki A, et al. Implantation of a Denver shunt by left subclavian approach for preventing kinking [J]. Hepatogastroenterology, 2009; 56(93): 10741077.
  25. 25. Rosemurgy AS, Zervos EE, Clark WC, et al. TIPS versus peritoneovenous shunt in the treatment of medically intractable ascites: a prospective randomized trial [J]. Ann Surg, 2004; 239(6): 883889.