Experience of perioperative treatment in patients with malignant ascites is crucial for surgeons to make the right choices. To meet general requirements, the following should be achieved: albumin > 2.5 mg%, GPT < 80 before and after surgery, which forms the basis of treating malignant ascites.
2.1 Emphasize sound sleep and rest to reduce hepatic metabolism and improve liver function; it can also reduce renal blood flow and water-sodium retention.
2.2 Consume a high-sugar, high-protein, moderate-fat diet while limiting water and sodium intake. According to reports, daily protein and calorie supplements should be as follows: bed rest requires 80g of protein/day and 2000 calories/day; getting out of bed requires 100g of protein/day and 2500 calories/day; for active individuals, protein intake should be 120g/day and heat intake should be 3000 calories/day. Summarizing, limiting water and sodium intake is very important to promote a low-salt diet. Postoperatively, fluid input should be controlled decadently, not exceeding 2000ml/day, with sodium chloride less than 1.5g. For early cirrhosis patients, strict control of water and sodium intake often leads to spontaneous diuresis, reducing ascites.
2.3 Regularly replenish lost plasma and albumin to improve overall condition and restore liver function. Improving plasma osmotic pressure is an important measure to promote ascites reduction and disappearance. For maximal resection in liver patients with solid liver tissue removed, if remaining liver tissue still cannot compensate, small amounts of multiple plasma and protein inputs are essential.
2.4 Reasonable application of diuretic drugs. In this group of cases, varying degrees of diuretics are used. The use of diuretic drugs must not be too hasty to avoid excessive short-term blood volume loss. Generally, combined, alternating, and intermittent use enhances diuretic effects and reduces side effects. Small and medium doses are recommended. Clinically, hydrochlorothiazide or furosemide (for potassium excretion) combined with spironolactone or triamterene (for potassium retention) is commonly used. Appropriate for refractory ascites, using natriuretic drugs like spironolactone + HCT + corticosteroids or mannitol can reduce weight by 0.5 daily. Scholars advocate intermittent use of laxatives: four to five days on, stopping for 2-3 days. Diuretics should pay attention to potassium supplementation, with a daily supplement of 4-8g. Attention should be paid to improving hypoproteinemia or increasing potassium excretion through diuretics = hypokalemia poor diuretic effect, often increases intestinal bacterial ammonia production = peripheral vasodilation, reduced renal blood flow. Using dopamine 20-40mg can cause peripheral vasoconstriction, increased cardiac output and renal blood flow. Furosemide will increase urine output.
2.5 Scholars have reported that patients with liver cirrhosis often show reduced L or _L only. The use of small doses of thyroid cable in treating refractory ascites has a certain effect. It can improve the appetite of cirrhosis patients, shorten ascites time, and speed up protein absorption. Serum albumin concentration =
2.6 Ascites reinfusion: After concentrating ascites directly, intravenous reinfusion is better. The reason is that large proteins can be saved, clearing water and electrolytes, and recoverable amounts of protein, increasing blood flow and volume, and improving liver function.
2.7 Ascites bypass: Pressure difference between thoracic and abdominal breathing makes ascites flow back into the superior vena cava. Professor Hu Zhenxiong from Suzhou Medical College reported good short-term results, but reducing ascites amount, increasing blood volume, overloading the heart, and causing heart failure and pulmonary edema easily induces procoagulant DIC.
Anesthesia and postoperative care are better than 3.1 surgical anesthesia. Management needs improvement, trying to maintain stable blood pressure to ensure good liver perfusion and avoid further liver function damage. Ether, halothane, or liver damage should be used cautiously. Prepare for blood transfusion before surgery to prevent long-stored blood input.
3.2 Postoperatively place an abdominal drainage tube to prevent postoperative ascites increase, leading to wound dehiscence. Set a bow [flow tube (silicone chamber tube is better) into the abdominal cavity for good drug diuretic effects. Release a small amount of ascites daily to ensure postoperative abdominal incision healing more effectively until the sutures are removed and the drainage camp is removed.
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