Töx U, Goeser T
Schwerpunkt Gastroenterologie und Hepatologie, Universität zu Köln, Köln.
Praxis (Bern 1994). 2005 May 4;94(18):727-33. doi: 10.1024/0369-8394.94.18.727.
Complications of liver cirrhosis are usually confined to advanced stages of the disease. Bleeding from esophageal or gastric varices may be prevented by treatment with beta-blockers or by endoscopic band ligation in case of large varices and intolerance for beta-blockers. Treatment of an acute bleeding episode from varices can efficiently be treated by endoscopic procedures, potentially in combination with drug therapy. In case of bleeding uncontrolled by endoscopy, TIPS is an effective alternative in selected patients. Treatment of ascites consists of reduction of sodium intake, aldosterone antagonists, and loop diuretics as needed. TIPS or repeated paracentesis may be necessary in refractory ascites. Spontanous bacterial peritonitis (SBP) must be sought and treated with antibiotics in conjunction with albumin administration in order to reduce mortality. Hepatorenal syndrome is characterized by a poor prognosis. Therefore, liver transplantation should be considered in appropriate patients.
肝硬化的并发症通常局限于疾病的晚期。对于食管或胃静脉曲张出血，可通过使用β受体阻滞剂进行治疗，或者在静脉曲张较大且对β受体阻滞剂不耐受的情况下，通过内镜下套扎术来预防。静脉曲张急性出血发作可通过内镜手术有效治疗，可能还需联合药物治疗。在内镜检查无法控制出血的情况下，经颈静脉肝内门体分流术（TIPS）对部分选定患者是一种有效的替代方法。腹水的治疗包括减少钠摄入、根据需要使用醛固酮拮抗剂和袢利尿剂。对于难治性腹水，可能需要进行TIPS或反复腹腔穿刺放液。必须查找自发性细菌性腹膜炎（SBP）并使用抗生素联合白蛋白治疗，以降低死亡率。肝肾综合征预后较差。因此，对于合适的患者应考虑肝移植。
