术前穿刺置管持续腹水引流对肝硬化伴顽固性腹水患者肝移植效果的影响

Effects of preoperative continuous paracentesis on liver transplantation in cirrhotic patients with refractory ascites

目的评价术前穿刺置管持续腹水引流对拟行肝移植的肝硬化伴顽固性腹水患者肝移植效果的影响。方法将2003年2月—2005年12月在我院行肝移植术的肝硬化伴顽固性腹水患者随机分为对照组(单纯药物治疗)和实验组(术前加穿刺置管腹水引流),分析治疗效果,并对肝移植疗效(包括随访)进行比较。结果实验组穿刺置管腹水引流操作中无并发症发生,治疗后症状缓解率明显高于对照组,体重降低,尿量增加,尿蛋白降低,移植后半年血肌酐明显低于治疗前。对照组治疗后较治疗前MELD评分分值显著性升高。结论术前穿刺置管持续腹水引流技术安全稳定,相比单纯药物治疗,综合治疗能够提高肝硬化伴顽固性腹水患者的术前状况。

Objective To evaluate influence of preoperative continuous paracentesis on liver transplantation in cirrhotic patients with refractory ascites. Methods From Feb.2003 to Dec .2005, 24 patients with cirrhosis and refractory ascites were randomly assigned to treatment with only drug therapy （12 patients） or continuous paracentesis combined with drug therapy （12 patients） .The effects on the transplantation were evaluated. Results No complications occurred in the paracentesis group, after transplantation, symptom, weight decrease, urine volume increase, urine protein decrease and serum creatinine decrease were significant. MELD scores in the control group notably increased markedly with only drug therapy. Conclusion Preoperative continuous paracentesis is safe. In comparison with drug therapy alone, the combination therapy can improve the condition of patients with refractory ascites before liver transplantation.