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目的:探讨中心静脉导管腹腔留置治疗重度卵巢过度刺激综合征(OHSS)合并张力性腹水的疗效。方法:将21例重度OHSS合并张力性腹水患者随机分为置管组和对照组。置管组(10例)在B超监视下采用Seldinger法置入中心静脉导管持续腹腔引流,同时联合扩容、对症等综合治疗;对照组则采用传统穿刺进行腹腔引流,观察其临床疗效。结果:置管组置管一次性成功率100%,置管引流后所有患者腹胀、纳差、呼吸困难症状均快速缓解,腹围及体质量较前明显下降(P<0.01),24 h尿量增多(P<0.01),平均置管天数为7.9±2.0 d,平均住院天数为10.6±2.7 d。与传统穿刺对照组比平均住院天数(12.2±2.3 d)稍有缩短(P>0.05),治疗费用明显降低(P<0.05)。除1例发生穿刺点腹水渗漏外,无其他严重并发症。结论:采用微创中心静脉导管腹腔留置治疗OHSS合并张力性腹水安全简便、经济有效,是一种可行方法。
Objective: To investigate the curative effect of central venous catheter placement in treatment of severe ovarian hyperstimulation syndrome (OHSS) with tension ascites. Methods: Twenty-one patients with severe OHSS complicated with ascites were randomly divided into catheter group and control group. The catheterization group (10 cases) underwent Seldinger’s method of continuous catheterization and continuous abdominal drainage under the supervision of B-ultrasound, combined with expansion and symptomatic treatment. The control group received conventional puncture for peritoneal drainage to observe the clinical effect. Results: The one-time success rate of catheterization was 100%. All the patients experienced rapid relief of abdominal distension, anorexia and dyspnea after catheter drainage. The abdominal circumference and body mass decreased significantly (P <0.01) (P <0.01). The average days of catheterization was 7.9 ± 2.0 days and the average length of stay was 10.6 ± 2.7 days. Compared with the traditional puncture control group, the average length of hospital stay (12.2 ± 2.3 days) was slightly shorter (P> 0.05), and the cost of treatment was significantly lower (P <0.05). No other serious complications were found except for one case of puncture ascites leakage. Conclusion: It is a safe and convenient method to treat OHSS with tension ascites by minimally invasive central venous catheterization.