腹水超滤浓缩腹腔回输术治疗肝硬化顽固性腹水的临床疗效

Efficacy of ascites ultrafiltration concentration and peritoneal reinfusion in the treatment of refractory cirrhotic ascites in 305 cases

目的观察应用腹水超滤浓缩回输腹腔治疗肝硬化顽固性腹水患者的临床疗效。方法以2019年1月至2020年12月解放军总医院第五医学中心住院治疗的305例肝硬化合并顽固性腹水患者作为研究对象,在常规治疗保肝、利尿等基础上,进行腹水回输治疗。观察治疗前后患者临床症状和体征(腹胀、纳差、体质量、腹围等),并检测血肌酐、尿素氮、白蛋白、血小板、血红蛋白、腹水常规等实验室指标。结果经腹水回输治疗后,274例(89.8%)患者临床症状改善,表现为体质量下降,腹围减小,腹胀及呼吸困难减轻,食欲改善。31例(10.2%)患者无明显效果或病情有进展。治疗中10例(3%)出现低血压,4例(1.3%)出现肌肉痉挛,2例(0.6%)出现腹部隐痛,术后均自行缓解,无严重并发症发生。治疗后患者血肌酐和尿素氮水平无明显升高,血清白蛋白水平明显上升(28.4 g/L比29.6 g/L,P<0.01),血小板计数有所下降(93.34×10^(9)/L比90.39×10^(9)/L,P=0.006),治疗前后血钠、INR、血红蛋白等指标无显著变化。结论对于肝硬化失代偿期合并顽固性腹水患者,在常规保肝、利尿等基础上,联合腹水回输治疗,可安全有效改善患者临床症状。

Objective To investigate the clinical efficacy of ascites ultrafiltration concentration and peritoneal reinfusion(referred to as ascites reinfusion)in the treatment for patients with refractory cirrhotic ascites.Methods A total of 305 patients with cirrhosis and refractory ascites admitted to our hospital from January 2019 to December 2020 were selected as the research objects.On the basis of conventional liver protection treatment and diuresis,ascites infusion therapy was performed.The clinical symptoms and signs(abdominal distention,anorexia,body weight,abdominal circumference,etc.)of the patients before and after treatment were observed.Laboratory indicators including serum creatinine(Scr),blood urea nitrogen(BUN),albumin,platelets,hemoglobin,and ascites routine were detected.Results After ascites reinfusion treatment,the clinical symptoms of 274 patients(89.8%)were improved,including weight loss,reduction in abdominal circumference,reduced bloating and dyspnea,and appetite improvement.Thirty-one patients(10.2%)had no obvious effect or progressed.During the treatment,10 patients developed hypotension(3%),4 patients muscle spasm(1.3%),and 2 patients mild abdominal pain(0.6%),all of which resolved spontaneously after operation and no serious complications occurred.After treatment,the Scr and BUN levels did not increase significantly,but the serum albumin level increased significantly(28.4 g/L vs.29.6 g/L,P=0.000),and the platelet count decreased(93.34×10^(9) vs.90.39×10^(9),P=0.006).There was no significant deference in serum sodium,international normalized ratio(INR),hemoglobin and other indicators before and after treatment.Conclusion Routine treatment combined with ascites reinfusion therapy can safely and effectively improve the clinical symptoms of patients with decompensated liver cirrhosis and refractory ascites.