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肝硬化难治性腹水的诊治进展OA

Advances in the Diagnosis and Treatment of Refractory Ascites in Liver Cirrhosis

中文摘要英文摘要

肝硬化难治性腹水是失代偿期肝硬化患者常见的严重并发症,腹水的出现预示着肝硬化患者生活质量和预后的双重下降.肝硬化患者腹水的产生最初由门静脉高压引发,但最终导致肾脏灌注不足加剧,从而出现难治性腹水.而炎症反应通过形成门静脉微血栓、持续加重门静脉高压,也在难治性腹水发病中起重要作用.难治性腹水发展过程中伴随多种并发症,其中以肾功能障碍、肾功能损伤最为常见.目前临床常用治疗方法包括限钠、利尿和反复放腹水等虽能短期缓解症状,但易导致电解质紊乱和肾功能损伤,长期效果有限.经颈静脉肝内门体分流术可降低门静脉压力并延长腹水复发时间、改善生活质量并提高生存率,但术后肝性脑病风险仍需关注;肝移植作为终末期治疗的最终手段,受限于供体资源和技术普及.未来研究需进一步优化治疗方案的选择,平衡疗效与风险,并通过多学科协作探索更低成本、更可持续的干预模式.

Refractory ascites of cirrhosis is a common and serious complication in patients with advanced cirrhosis.Its treatment is difficult and has a poor prognosis,which poses a significant burden on the patient's quality of life and the medical system.At pres-ent,clinical treatment methods have problems with localized efficacy and obvious side effects.It is urgent to systematically summarize the existing research progress and explore better solutions.This paper compares and analyzes the clinical value of traditional treatment methods and new intervention strategies by sorting out recent literature,combining the pathological mechanism and clinical practice of refractory ascites with cirrhosis.Studies have found that although traditional methods such as sodium limiting,diuretics and repeated ascites can relieve symptoms in the short term,they can easily lead to electrolyte disorders and kidney damage,and have limited long-term effects.In the new treatment,transjugate intrahepatic portal shunt(TIPS)can significantly reduce portal venous pressure and pro-long the recurrence of ascites,but the risk of hepatic encephalopathy after surgery still needs attention;ascites concentrating and retraction technology can reduce albumin consumption and maintain circulatory stability,but the operational cost is high;liver trans-plantation,as the final means of end-stage treatment,is limited by the popularization of donor resources and technology.Future research needs to further optimize the indication selection of treatment plans,balance efficacy and risks,and explore lower-cost and more sustainable intervention models through multidisciplinary collaboration.

WEI Minhua;ZHOU Junying

Department of Infectious Diseases,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,ChinaDepartment of Infectious Diseases,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China

医药卫生

肝硬化难治性腹水门静脉高压自发性细菌性腹膜炎経颈静脉肝内体分流术肝移植

CirrhosisRefractory ascitesPortal hypertensionSpontaneous bacterialperitonitisTransjugate intrahepatic portal shunt(TIPS)Liver transplantation

《西南医科大学学报》 2026 (1)

12-15,67,5

河北省医学适用技术跟踪项目(GZ2023019)

10.3969/j.issn.2096-3351.2026.01.003

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