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중증 간경화증환자에 (肝硬化症患者) 동반된 난치성 (難治性) 복수의 (腹水) 초여과에 (超濾果) 의한 치료효과
기춘석(Chun Suk Ki),박경남(K N Park),이호채(H C Lee),황흥곤(H C Hwang),정병천(B C Chung),허동헌(D H Hur),박한철(H C Park) 대한소화기학회 1983 대한소화기학회지 Vol.15 No.1
N/A There had been a considerable trouble in the management of refractory acites combined with liver cirrhosis. Such refractory ascites in advanced liver cirrhosis does not respond to conventicnal therapy such as bed rest, salt restriction, massive diuretics and albumin infnsion. And there are also serious corrplications including hepatic encephalopathy, functicnal renal failure and hyponatremia with massive administration of diuretics. So peritoneovenous shunt(Leveen shunt) had been developed in order to promote effective circulatory volume with increased renal function. But relatively large and serious complications such as DIC, fever, infection, pulmonary edema and pulmonary embolism had limited its widespread use in the magement of refractory ascites. So we have experienced intraperitoneal reinfusion of ultrafiltered ascites for 20 patients with intractable ascites combined with liver cirrhosis. We had performed this procedure via ultrafilter which was usually used in hemodialysis and pump. And the following results werc acquired. 1. About 6200 cc of acites was ultrafiltered for average 4. 5 hrs. and loss of body weight was 6.7kg which was more than the amount of filtered ascites. 2, Increasing tendency in serum albumin concentration after ultrafiltration with peak concentration about 0. 5 gm/dl gain at 3rd after this procedure. There were significant increase in the amount of daily urine output but statisitically nonsignificant increase in creatinine clearance. 4, The complications of this procedure were light headache, hearing disturbance, dizziness and there was no more serious complication such as DIC, variceal rupture, pulmonary edema. There was no recurrence of reaccumulation of ascites within 3 months with one time procedure in a certain case. The repeated with average of 4-6 weeks interval had controlled such refractory ascites. In summary, above results supported that intraperitoneal reinfusion of ultrafiltered ascites have beneficial effect in the control of refractory ascites combined with far advanced liver cirrhosis. The advantages of this procedure are the followings. 1.Low cost. 2. Time saving. 3. Ambulatory control. 4 Less complication. 5. Corresponding effect to intravenous albumin infusion (4-5 bottles)