腹腔恶性肿瘤伴大量腹水所致慢性腹内高压对相关脏器功能的影响

Massive ascites-related intraabdominal hypertension in abdominal malignances

目的了解慢性腹内高压对机体多个系统和器官功能的影响。方法选择2004年1月至2008年1月在北京大学人民医院住院确诊腹腔恶性肿瘤伴大量腹水的慢性腹内高压患者共30例，包括结肠癌12例，胰腺癌7例，胃癌11例。另选取同期住院腹腔恶性肿瘤但不伴腹水患者30例作为对照组，其中结肠癌15例，胰腺癌8例，胃癌7例。统计两组患者的循环系统、呼吸系统、消化系统症状及肝功能、肾功能、一般体力状况KPS评分。结果慢性腹内高压组有气喘、胸闷等呼吸道症状者为9例（30％），腹部胀满感15例（50％），心悸、低血压10例（33％），肝功能异常16例（53％），肾功能异常14例（47％），KPS评分低于40者22例（73％），以上各指标均显著高于对照组（分别为3％、16％、10％、20％、3％、23％）（P〈0.05）。结论慢性腹内高压可导致机体循环系统、呼吸系统、消化系统功能不全，并对患者一般状况造成显著影响。慢性腹内高压亦可出现腹腔间隔综合征。

Objective To study the effects of chronic intra-abdominal hypertension （IAH） on the functions of vital organs. Methods From January 2004 to January 2008, 30 chronic massive ascites related IAH patients were enrolled including 12 colonic cancer cases, 7 pancreatic cancer cases, and 11 gastric cancer cases. Control group included 30 cases of gastrointestinal carcinoma without ascites hence no IAH. The specific malignances in this group were colonic cancer in 15 cases, pancreatic cancer in 8 cases, and gastric cancer in 7 cases. Age, gender and cancer stage were matched between the two groups. Symptoms in digestive, respiratoy and circulatory system and liver and kidney functions were recorded and KPS scores were compared respectively. Results The symptoms of abdominal distention in chronic IAH group and control group were presented respectively by 15 cases（50%） and 5 cases （17%） （P〈0.01）. Symptoms of heart-throb or hypotension in the two groups by 10 cases （33%） and 3 cases （10%） respectively（P〈0.05）. Symptoms of asthma or chest distress in the two groups by 9 cases （30%） and 1 cases （3%） respectively （P〈0.01）. Liver function were abnormal in 16 cases （53%） and 6 cases （20%） respectively （P〈0.01）, kidney functions were abnormal in 14 cases（47%） and 1 case（3%） respectively （P〈0.01） . There were 22 cases（73%） and 7 cases （23%） respectively （P〈0.01） in the two groups with KPS score being lower than 40. Conclusions Chronic IAH causes malfunctions of vital organs deteriorating patients general status and even leading to abdominal compartment syndrome.