Brown M W, Burk R F
Am J Med. 1986 May;80(5):879-83. doi: 10.1016/0002-9343(86)90632-7.
Recently, two patients with cirrhosis in whom ascites intractable to medical therapy had developed were referred to Medical Center Hospital and Audie L. Murphy Memorial Veterans Administration Hospital. Ascites had developed in both following upper abdominal surgery. To better characterize postoperative ascites, the records of all patients with cirrhosis who had upper abdominal operations at these hospitals during a five-year period were reviewed. Patients with portacaval shunts or pre-existing ascites were excluded. Of the 31 patients meeting the study requirements, ascites developed in 12 in the immediate postoperative period. In 10, the ascites resolved with medical management. As a group, these 10 patients had more severe liver disease than the group in whom ascites did not develop. The remaining two patients had ascites intractable to medical therapy. The ascitic fluid protein level was high in these two patients as well as in the two referred patients with a mean value of 4.5 +/- 1.6 g/dl. One patient with intractable ascites died and the other three required operative management. No clinical or laboratory features distinguished the patients in whom intractable ascites developed from the patients in whom postoperative ascites did not develop. It is suggested that intraoperative injury to vessels draining hepatic lymph was the cause of the intractable ascites.
最近，两名肝硬化患者因难治性腹水被转诊至医疗中心医院和奥迪·L·墨菲纪念退伍军人管理局医院。这两名患者均在上腹部手术后出现腹水。为了更好地描述术后腹水的特征，我们回顾了这两家医院在五年期间接受上腹部手术的所有肝硬化患者的病历。排除了有门腔分流术或术前已有腹水的患者。在符合研究要求的31名患者中，有12名在术后即刻出现腹水。其中10名患者通过药物治疗腹水得以消退。总体而言，这10名患者的肝病比未出现腹水的患者更为严重。其余两名患者的腹水对药物治疗无效。这两名患者以及两名转诊患者的腹水蛋白水平较高，平均值为4.5±1.6 g/dl。一名难治性腹水患者死亡，另外三名患者需要手术治疗。在出现难治性腹水的患者和未出现术后腹水的患者之间，没有临床或实验室特征可以区分。提示术中肝淋巴引流血管损伤是难治性腹水的原因。
