DeSitter L, Rector W G
Am J Gastroenterol. 1984 Feb;79(2):136-8.
Five percent of cirrhotic patients with ascites in our unit have grossly bloody fluid. Eleven of 32 randomly selected retrospective patients had hepatocellular carcinoma, one tuberculous peritonitis, seven prior trauma, and in 13 the bloody ascites was apparently spontaneous. Five prospectively encountered patients brought the number of cases of spontaneous bloody ascites available for review to 18. Three of these had sudden large intraperitoneal hemorrhages, and bloody ascites in the remaining 15 was incidentally noted at routine diagnostic paracentesis. Bleeding in the former three patients was from a retroperitoneal vein, spontaneous splenic rupture, and an unknown site, respectively. All patients required laparotomy and two died. Ascites red cells in the latter 15 patients may have been from a slowly leaking collateral vein or a hepatic lymphatic and required no treatment. However, the prognosis of these patients was significantly poorer than that of a control group of patients with similar liver tests and clear ascites.
在我们科室，5%的肝硬化腹水患者有明显血性腹水。在随机选取的32例回顾性研究患者中，11例患有肝细胞癌，1例患有结核性腹膜炎，7例有既往创伤史，13例的血性腹水显然是自发性的。5例前瞻性研究患者使可供审查的自发性血性腹水病例数达到18例。其中3例发生了突然的大量腹腔内出血，其余15例的血性腹水是在常规诊断性腹腔穿刺时偶然发现的。前三例患者的出血分别来自腹膜后静脉、自发性脾破裂和一个不明部位。所有患者均需接受剖腹手术，2例死亡。后15例患者的腹水红细胞可能来自缓慢渗漏的侧支静脉或肝淋巴管，无需治疗。然而，这些患者的预后明显比肝功能检查类似且腹水清澈的对照组患者差。
