Kawaratani Hideto, Fukui Hiroshi, Yoshiji Hitoshi
Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
Hepatol Res. 2017 Feb;47(2):166-177. doi: 10.1111/hepr.12769. Epub 2016 Jul 27.
Common complications of decompensated liver cirrhosis are esophageal varices, hepatic encephalopathy and ascites. After the onset of complications, the prognosis worsens. In patients with ascites, the 5-year mortality rate is 44%. Furthermore, hyponatremia, spontaneous bacterial translocation and hepatorenal syndrome also greatly worsen the prognosis. Effective treatment of cirrhotic ascites improves the quality of life and survival rate. Recently, the newly produced diuretic, tolvaptan (vasopressin V2 receptor antagonist), was reported to be effective in the treatment of refractory ascites in liver cirrhosis; however, there has not been an associated positive effect on the prognosis. There are various types of treatment for ascites, such as large-volume paracenteses, a cell-free and concentrated ascites reinfusion therapy, a transjugular intrahepatic portosystemic shunt, and a peritoneo-venous shunt. Although they improve the prognosis, liver transplantation remains the ultimate form of treatment. The present article discusses the therapeutic management of cirrhotic ascites.
失代偿期肝硬化的常见并发症包括食管静脉曲张、肝性脑病和腹水。并发症出现后，预后会恶化。腹水患者的5年死亡率为44%。此外，低钠血症、自发性细菌移位和肝肾综合征也会极大地恶化预后。有效治疗肝硬化腹水可提高生活质量和生存率。最近，有报道称新生产的利尿剂托伐普坦（血管加压素V2受体拮抗剂）对治疗肝硬化难治性腹水有效；然而，对预后并无相关积极影响。腹水有多种治疗方法，如大量腹腔穿刺放液、无细胞浓缩腹水回输疗法、经颈静脉肝内门体分流术和腹腔静脉分流术。尽管这些方法可改善预后，但肝移植仍是最终的治疗方式。本文讨论了肝硬化腹水的治疗管理。
