Objective To assess the therapeutic efficacy of central venous catheter placement via abdominal puncture in the treatment of refractory ascites. Methods Thirty- six patients with refractory ascites due to cirrhosis who were unresponsive to albumin supplement and diuretic treatment and admitted to our hospital from July 2010 to March 2011 were included in this study. Intraperitoneal catheter drainage was performed in these patients, in which generally not more than 800 ml of ascites was drained in the first session and subsequently 1500- 2000ml of ascites was drained daily; in addition, human albumin ( 10 g / d) was infused, and spironolactone ( 400 mg / d) and furosemide ( 160mg / d) were orally given. Results Reduction in ascites volume, ultrasound examination results, urine volume, and time of stable condition were monitored after 12 days of treatment. Abdominal distension was relieved in all patients after 3 days of treatment. After 12 days of treatment, 17 cases ( 47. 2%) showed a complete response, 15 cases ( 41. 7%) showed a partial response, and 4 cases ( 11. 1%) showed no response, with a response rate of 88. 9%. Conclusion The placement of a central venous catheter in the abdominal cavity reduces the number of punctures and lowers the incidence of hepatorenal syndrome. The central venous catheter offers a convenient, safe, and easy- to- use tool for sustained peritoneal drainage in the treatment of intractable ascites.
[1]ZHANG W, XU XP, QU ZS, et al.Central venous catheter dailydrainage in treating 35 cases of refractory ascites[J/CD].Chin J Liver Dis (Electron Vers) , 2009, 1 (2) :17-23. (in Chinese) 张炜, 徐小平, 瞿章书, 等.中心静脉导管每日引流法治疗35例难治性腹水[J/CD].中国肝脏病杂志 (电子版) , 2009, 1 (2) :17-23.
|
[2]ZHANG RF, LI YL.Abdominal indwelling catheter in treatment of 40cases of intractable ascites[J].J North China Coal Medical University, 2004, 6 (2) :165. (in Chinese) 张瑞凤, 李玉林.腹腔内留置导管治疗顽固性腹水40例体会[J].华北煤炭医学院学报, 2004, 6 (2) :165.
|
[3]XIANG Q, YUE GP, WANG YZ, et al.The change of blood pressure and discharge ascites hepatorenal syndrome[J].China Foreign Med Treat, 2010, 1 (2) :22-23. (in Chinese) 向谦, 岳广平, 王永占, 等.排放腹水前后血压变化与肝肾综合征的发生[J].中外医疗, 2010, 1 (2) :22-23.
|
[4]GINèS P, TITLL, ARROYO V, et al.Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis[J].Gastroenterology, 1988, 94 (6) :1493-1502.
|
[5]GINS A, FERNNDEZ-ESPARRACH G, MONESCILLO A, et al.Randomized trial coparing albumin, dextran 70, and polygeline in cirrhotic patient with ascites treated by paracentesis[J].Gastroenterology, 1996, 111 (4) :1002-1010.
|
[6]GINS A, PLANAS R, ANGELI P, et al.Treatment of patients with cirrhosis and refractory ascites using the LeVeen shunt with titanium tip:coparison with therapeutic paracentesis[J].Hepatology, 1995, 22 (1) :124-131.
|
[7]RUNYON BA.Practice Guidelines Committee, American Association for the Study of Liver Diseases (AASLD) .Management of adult patients with ascites due to cirrhosis[J].Hepatology, 2004, 39 (3) :841-856.
|