Clinical effects of comprehensive nursing intervention in combination with comprehensive treatment and abdominal puncture for treatment of liver cirrhosis with refractory ascites

AIM: To investigate the clinical effects of comprehensive nursing intervention in combination with comprehensive treatment and abdominal puncture in the treatment of liver cirrhosis with refractory ascites.

METHODS: One hundred and twenty patients with cirrhosis and ascites were randomly divided into an observation group and a control group. Both groups of patients were given comprehensive treatment including limited water sodium restriction, diuretics, and infusing albumin injection. After one week of treatment, abdominal paracentesis was performed in cases whose ascites did not regress obviously. On the basis of the above treatment, the observation group received comprehensive nursing intervention, and the control group was given conventional nursing. Clinical effects, satisfaction to nursing, complications, and improvements of psychological function, social function and life ability were compared for the two groups.

RESULTS: The total effective rate was significantly higher in the observation group than in the control group (95% vs 75%, P < 0.05). The percentages of patients who were satisfied with nursing was also significantly higher in the observation group (98.3% vs 85%, P < 0.05). The incidence of complications was significantly lower than that the control group (10% vs 25%, P < 0.05). The psychological function score, life ability score, and social function score were significantly better than those the control group (38.32 ± 6.85 vs 30.85 ± 8.86; 39.75 ± 5.85 vs 32.86 ± 6.46; 39.83 ± 3.46 vs 14.74 ± 3.45, P < 0.05).

CONCLUSION: Comprehensive nursing intervention in combination with comprehensive treatment and abdominal puncture in the treatment of intractable ascites due to cirrhosis can effectively improve clinical effects, patients' psychological function, social function and life ability, reduce the incidence of complications, improve prognosis, and promote rehabilitation.

Peritoneovenous shunt for intractable ascites due to hepatic lymphorrhea after hepatectomy

A peritoneovenous shunt has become one of the most efficient procedures for intractable ascites due to liver cirrhosis. A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular carcinoma that was successfully treated by the placement of a peritoneovenous shunt is presented. A 72-year-old Japanese man underwent partial resection of the liver for hepatocellular carcinoma associated with hepatitis C viral infection. After hepatectomy, a considerable amount of ascites ranging from 800-4600 mL per day persisted despite conservative therapy, including numerous infusions of albumin and plasma protein fraction and administration of diuretics. Since the patient’s general condition deteriorated, based on the diagnosis of intractable hepatic lymphorrhea, a subcutaneous peritoneovenous shunt was inserted. The patient’s postoperative course was uneventful and the ascites decreased rapidly, with serum total protein and albumin levels and hepatic function improving accordingly. For intractable ascites due to hepatic lymphorrhea after hepatectomy, we recommend the placement of a peritoneovenous shunt as a procedure that can provide immediate effectiveness without increased surgical risk.

A case of successful management with splenectomy of intractable ascites due to congenital dyserythropoietic anemia type II-induced cirrhosis

The congenital dyserythropoietic anemias comprise a group of rare hereditary disorders of erythropoiesis, characterized by ineffective erythropoiesis as the predominant mechanism of anemia and by characteristic morphological aberrations of the majority of erythroblasts in the bone marrow. Congenital dyserythropoietic anemia type II is the most frequent type. All types of congenital dyserythropoietic anemias distinctly share a high incidence of iron loading. Iron accumulation occurs even in untransfused patients and can result in heart failure and liver cirrhosis. We have reported about a patient who presented with liver cirrhosis and intractable ascites caused by congenital dyserythropoietic anemia type II. Her clinical course was further complicated by the development of autoimmune hemolytic anemia. Splenectomy was eventually performed which achieved complete resolution of ascites, increase of hemoglobin concentration and abrogation of transfusion requirements.