肝硬化顽固性腹水的治疗现状

Current status of treatment of refractory ascites in patients with liver cirrhosis

腹水是肝硬化门静脉高压的常见临床表现，10年内约有60%-80％的肝硬化患者出现腹水症状，一旦出现腹水5年生存率即由80％降至50％，随着肝脏疾病的进展每年约有5％～10％的腹水进展为难治性，其中位生存时间仅为6～12个月。现主要对顽固性腹水的定义及诊断，评估预后的因素，大量放腹水联合补蛋白、经颈内静脉肝内门体分流术及肝移植3项治疗及其他新的治疗作一概述。

Ascites is a common clinical manifestation of cirrhotic portal hypertension, and about 60%-80% of cirrhotic patients develop the symptom of ascites within 10 years. Once ascites occurs, the 5-year survival rate is reduced from 80% to 50%. With the progression of liver diseases, approximately 5%-10% of patients with ascites develop refractory ascites, and the median survival time is only 6-12 months. This article reviews the definition and diagnosis of refractory ascites, evaluation of prognostic factors, and treatment regimens, including large-volume paracentesis combined with protein supplementation, transjugular intrahepatic portosystemic shunt, and liver transplantation.