Nadir Abdul, Van Thiel David H
Maricopa Medical Centre, Phoenix AZ, USA.
J Ayub Med Coll Abbottabad. 2010 Jan-Mar;22(1):37-41.
Ascites is a common clinical manifestation of advanced liver disease which can be managed with repeated large volume paracentesis. We sought to determine if continuous paracentesis via placement of an indwelling catheter for the management of ascites is safe and effective.
We placed 38 peritoneal drainage catheters in 30 patients for durations ranging from 1-10 days. Patients underwent ascites fluid culture and cell count determinations immediately before and after the completion of paracentesis. Serum WBC count, BUN and creatinine levels were available on all patients before and after paracentesis. The descriptive data were analysed to assess the rate of peritoneal infections, change in renal function and ultimate clinical outcome of patients.
A mean 12.73 litres of peritoneal fluid was removed via continuous peritoneal drainage accomplished with the use of an indwelling abdominal catheter. Eight peritoneal cultures obtained after paracentesis grew out. The mean peritoneal cell count before and after paracentesis in each subject did not show evidence for spontaneous bacterial peritonitis. Five patients underwent successful liver transplantation (OLTX) and did not develop any peritoneal infections post OLTX.
Continuous large volume paracentesis using an indwelling abdominal catheter for several days is effective in removing large volumes of peritoneal fluid in patients with endstage-liver-disease (ESLD). The peritoneal fluid can grow out bacteria if it is left in the abdomen for > or = 3 days.
腹水是晚期肝病的常见临床表现，可通过反复大量腹腔穿刺术进行处理。我们试图确定通过放置留置导管进行持续性腹腔穿刺术治疗腹水是否安全有效。
我们为30例患者放置了38根腹膜引流导管，持续时间为1至10天。患者在腹腔穿刺术完成前后立即进行腹水培养和细胞计数测定。所有患者在腹腔穿刺术前后均有血清白细胞计数、血尿素氮和肌酐水平的数据。对描述性数据进行分析，以评估腹膜感染率、肾功能变化及患者的最终临床结局。
通过使用留置腹腔导管进行持续腹膜引流，平均引出12.73升腹膜液。腹腔穿刺术后获得的8份腹膜培养物有细菌生长。每个受试者腹腔穿刺术前后的平均腹腔细胞计数未显示自发性细菌性腹膜炎的迹象。5例患者成功接受肝移植（原位肝移植），肝移植后未发生任何腹膜感染。
使用留置腹腔导管进行持续大量腹腔穿刺术数天，对于晚期肝病（ESLD）患者有效引出大量腹膜液。如果腹膜液在腹腔内留置≥3天，可能会有细菌生长。
