Fisher J, Calkins W G
Am J Gastroenterol. 1978 Jun;69(6):689-93.
Three cases of spontaneous umbilical hernia rupture in patients with alcoholic liver disease and ascites are reported. Eighteen cases have been previously reported in the literature. These 21 cases are reviewed in an attempt to determine precipitating events, prognostic factors, complications, and the results of therapy. All patients had significant ascites prior to umbilical rupture. Ulceration of the umbilicus prior to rupture was common (81%). The subsequent presence of peritonitis, hypotension, renal failure, gastrointestinal hemorrhage or hepatic coma was associated with significant mortality (80%). All patients with a serum albumin above 2.4 gm./dl. survived. There were no survivors in those patients who did not receive surgical treatment. Based upon the outcome of these 21 patients optimal treatment of this disorder would seem to be early surgical repair of the umbilical hernia, appropriate fluid and electrolyte replacement, antiobiotics and measures to reduce intraabdominal pressure.
本文报告了3例酒精性肝病合并腹水患者自发性脐疝破裂的病例。此前文献中已有18例相关报道。现对这21例病例进行回顾，以确定诱发因素、预后因素、并发症及治疗结果。所有患者在脐疝破裂前均有大量腹水。破裂前脐部溃疡很常见（81%）。随后出现腹膜炎、低血压、肾衰竭、胃肠道出血或肝昏迷与高死亡率相关（80%）。血清白蛋白高于2.4克/分升的所有患者均存活。未接受手术治疗的患者无一存活。基于这21例患者的治疗结果，本病的最佳治疗方法似乎是早期手术修复脐疝、适当补充液体和电解质、使用抗生素以及采取措施降低腹内压。
