食管静脉曲张硬化剂注射及套扎治疗对腹水的影响

Influence of esophageal variceal sclerotherapy and loop ligature therapy on ascites

目的探讨食管静脉曲张硬化剂注射及套扎治疗对肝硬化患者腹水的影响。方法筛选出74例进行硬化及套扎治疗并伴有腹水的患者,观察患者腹水的变化情况,进行统计分析。结果①2次以上住院治疗者32例,其中15例发生腹水增加,17例腹水未增加,腹水增加和未增加患者例数接近,无显著性差异;15例腹水增加患者中同时伴有肝功能Child-pugh分级恶化和/或白蛋白下降者13例,占腹水增加例数的87%,2例肝功能A级,无肝功恶化及白蛋白下降,占腹水增加例数的13%;经卡方检验,腹水增加与肝功能恶化及白蛋白下降明显相关,P<0.05。②仅1次住院治疗者42例,入院时伴有腹水,其中肝功能Child-pugh分级A级26例(62%)经治疗后腹水均消退。结论食管静脉曲张硬化及套扎治疗与治疗后腹水增加无明显相关性,血清白蛋白水平及肝功能状况仍是硬化及套扎治疗后腹水增加的主要原因。

Objective It is to discuss the influence of esophageal variceal sclerotherapy and loop ligature therapy on ascites of hepatic cirrhosis patients. Methods 74 sclerotherapy and loop ligature therapy patients with ascites were screened. The changes of ascites were observed and analyzed with statistics. Results （1）In 32 patients hospitalized more than twice, 15 cases had the increase of ascites, while the other 17 cases had not. 13 cases out of 15 patients （87%） manifested worsen liver function （Child-pugh class） and/or decreased serum level of albumin. Only two cases out of 15 patients （13%） were normal in liver function （Child-pugh A） and the serum level of albumin. The increase of ascites was correlated with worsen liver function and decreased albumin level （Chi-square test, P 〈 0.05 ）. （2） In 42 patients hospitalized only once, 26 cases （62 % ） with nearly normal liver function tests （Child-pugh A） had disappeared ascites after treatment. Conclusion Esophageal variceal sclerotherapy and loop ligature therapy have an indefinite relationship with the increase of ascites, while the serum level of albumin and the liver function remain to be the major factors of the increase of ascites in patients treated with sclerotherapy and loop ligature therapy.