腹水浓缩回输治疗肝癌合并顽固性腹水47例

The curative effect of reinfusing the concentrated ascites into abdominal cavity for refractory ascites in 47 cases of hepato-cellular carcinoma in 47 cases

目的观察腹水浓缩腹腔回输治疗肝癌合并顽固性腹水的并发症与疗效。方法对47例肝癌合并顽固性腹水患者进行73次腹水超滤浓缩,经腹腔回输体内。结果腹水回输相关事件8次,占10.9%(8/73);轻中度并发症7例,占9.5%(7/73);严重并发症6例次,占8.2%(6/73);治疗后腹围(92.8±4.5)cm与治疗前(98.7±7.3)cm比较,明显下降(P<0.05),治疗后每日尿量(1880.5±201.6)mL与治疗前(986.8±158.5)mL比较,明显增加(P<0.05);腹胀明显缓解且血压无明显下降。首次腹水回输后3～5d内死亡5例,15d、1个月病死率分别为23.9%、41.3%;3个月、1年病死率分别为78.2%、93.4%。结论腹水浓缩回输对肝癌合并顽固性腹水减轻症状有一定疗效,但不能改善患者预后。

Objective To observe the complications and efficacy of reinfusion ascitic concentration into abdominal cavity for refractory ascites in patient with hepatocellular carcinoma. Methods Forty-seven patients with hepatocellular carcinoma and refractory ascites were treated with ascitic concentration and reinfusion device for 73 times. Results There were 8/73 （10.9 %） events related to ascites reinfusion. Complications were identified among 73 therapies, while 7 （9.5 % ） were mild to moderate, and 6 （8.2%） were severe. After treatment, the abdomen circumference of the patients obviously decreased from （98.7 ＋ 7.3） cm to （92.8 ＋ 4. 5） cm （P〈0.05） and the volume of urines significantly increased from （986.8 ＋ 158.5） mL to （1 880.5 ＋ 201.6） mL （P〈0.05）. Abdominal distension was significantly ameliorated and there was no noticeable decline of blood pressure. Five patients died in 3 to 5 days after the treatment. The mortality rates of 0. 5 m, 1 m, 3 m and 1 year were 23.9%, 41.3%, 78. 2% and 93.4%, respectively. Conclusion Ascitic concentration and reinfusion to abdominal cavity could palliate the symptoms of refractory ascites, but could not change the outcomes of HCC patients.