肝移植术后难治性腹水的诊断与治疗五例

Diagnosis and treatment of 5 cases of refractory ascites after liver transplantation

目的总结肝移植术后难治性腹水的诊断和治疗经验。方法回顾性分析5例肝移植术后难治性腹水患者的临床表现、检查结果、治疗经过及转归。结果5例患者中，2例为结核性腹膜炎，经抗结核治疗，1例治愈，另1例好转；1例为肝小静脉闭塞症，经皮质激素＋经颈静脉肝内门体静脉分流术（TIPS）治疗，治愈；1例为流出道梗阻，行TIPS后治愈；1例为淋巴漏，患者因。肾功能衰竭，发生剥脱性皮炎．死于多器官功能衰竭。结论肝移植术后难治性腹水临床症状不典型，辅助检查诊断阳性率不高，病因确定困难，需结合临床症状及辅助检查结果，全面分析、仔细甄别，必要时给予诊断性抗结核治疗方能明确诊断。

Objectire To summarize the experiences in diagnosis and treatment of refractory ascites （RA） after liver transplantation （LT）. Method Clinical data of 5 patients with RA after LT, including clinical characteristics, auxiliary examinations, treatment as well as outmcomes were retrospectively analyzed, Result Among the five patients, two cases was diagnosed as tuberculous peritonitis and given anti-tuberculosis therapy： one of them was cured, and another is still receiving treatment and the symptoms was obviously alleviated. One case of hepatic venous occlusion disease and one case of outflow obstruction relieved without complications after given TIPS therapy. The rest one was diagnosed as lymphatic fistula and died of multiple organ failure because of renal failure and ex{oliative dermatitis. Concision It is very difficult to demonstrate the etiological diagnosis of RA because of atypical clinical symptoms and low positive rate of auxiliary examinations. With clinical symptoms, auxiliary examination, comprehensive analysis and carefully screening, even diagnosis can be made with undergoing diagnostic treatment of anti-tuberclosis to cases of RA after LT.