肝硬化顽固性腹水治疗现状

doi:10.3969/j.issn.1672-5069.2020.05.039

摘要/Abstract

摘要： 目的腹水是失代偿期肝硬化的常见表现,其中顽固性腹水的发病率为5%～10%,患者生存率低。国内外大量研究对顽固性腹水的治疗进行了研究报道,并取得了一定的进展。本文针对目前顽固性腹水的治疗现状和进展进行了较为系统的综述。

关键词: 顽固性腹水, 腹腔穿刺大量放腹水, 经颈静脉肝内门体分流术, 特利加压素, 托伐普坦 , ,

Abstract: Objective Ascites is a common manifestation of decompensated liver cirrhosis. The incidence of refractory ascites (RA) in patients with cirrhosis is about 5% to 10%, and the survival of patients with RA is low. A number of studies at home and abroad have reported the progress of treatment on RA. We reviewed the current treatment of RA in patients with cirrhosis.

Key words: Refractory ascites, Large volume paracentesis, TIPS, Terlipressin, Tolvaptan

张鑫赫(综述), 李异玲(审校). 肝硬化顽固性腹水治疗现状[J]. 实用肝脏病杂志, 2020, 23(5): 757-760.

Zhang Xinhe,Li Yiling.. Treatment of refractory ascites in patients with liver cirrhosis[J]. Journal of Practical Hepatology, 2020, 23(5): 757-760.

参考文献

[1] Caly WR,Abreu RM,Bitelman B,et al.Clinical features of refractory ascites in outpatients.Clinics(Sao Paulo),2017,72(7):405-410.
[2] Shao J,Zhang L,Han GH,et al.Current status of treatment of refractory ascites in patients with liver cirrhosis. 中华肝脏病杂志,2016,24(10):721-723.
[3] 中华医学会肝病学分会.肝硬化腹水及相关并发症的诊疗指南.实用肝脏病杂志,2018,21(1):21-31.
[4] Neong SF,Adebayo D,Wong F.An update on the pathogenesis and clinical management of cirrhosis with refractory ascites. Expert Rev Gastroenterol Hepatol,2019,13(4):293-305.
[5] Adebayo D,Neong SF,Wong F.Refractory ascites in liver cirrhosis.Am J Gastroenterol,2019,114(1):40-47.
[6] 成美娇,郑伟强.肝硬化顽固性腹水的治疗进展.海南医学,2019,30(2):252-255.
[7] Sudulagunta SR,Sodalagunta MB,Bangalore Raja SK,et al.Clinical profile and complications of paracentesis in refractory ascites patients with cirrhosis.Gastroenterol Res,2015,8(3-4):228-233.
[8] Tan HK,James PD,Wong F.Albumin may prevent the morbidity of paracentesis-induced circulatory dysfunction in cirrhosis and refractory scites: A pilot study.Dig Dis Sci,2016,61(10):3084-3092.
[9] Garbuzenko DV,Arefyev NO.Current approaches to the management of patients with cirrhotic ascites.World J Gastroenterol,2019,25(28):3738-3752.
[10] Di Pascoli M,Fasolato S,Piano S,et al. Long‐term administration of human albumin improves survival in patients with cirrhosis and refractory ascites.Liver Int,2019,39(1):98-105.
[11] Makhlouf NA,Mahran ZG,Sadek SH,et al.Six-minute walk test before and after large-volume paracentesis in cirrhotic patients with refractory ascites: A pilot study.Arab J Gastroenterol,2019,20(2):81-85.
[12] Macken L,Mason L,Evans C,et al.Palliative long-term abdominal drains versus repeated drainage in individuals with untreatable ascites due to advanced cirrhosis: study protocol for a feasibility randomised controlled trial.Trials,2018,19(1):401.
[13] Solbach P,Honer Zu Siederdissen C,et al.Home-based drainage of refractory ascites by a permanent-tunneled peritoneal catheter can safely replace large-volume paracentesis.Eur J Gastroenterol Hepatol,2017,29(5):539-546.
[14] 杨帆,程黎娜,张玲娟,等.TIPS用于肝硬化门脉高压对患者远期预后的影响.肝脏,2019,24(8):893-895.
[15] 曹家伟,丁鹏绪,段峰,等.中国门静脉高压经颈静脉肝内门体分流术临床实践指南(2019年版).临床肝胆病学杂志,2019,35(12):2694-2699.
[16] Allaire M,Walter A,Sutter O,et al.TIPS for management of portal-hypertension-related complications in patients with cirrhosis. Clin Res Hepatol Gastroenterol,2019.
[17] Burgos AC,Thornburg B.Transjugular intrahepatic portosystemic shunt placement for refractory ascites: Review and update of the literature.Semin Intervent Radiol,2018,35(3):165-168.
[18] Kwan SW,Allison SK,Gold LS,et al.Cost-effectiveness of transjugular intrahepatic portosystemic shunt versus large volume paracentesis in refractory ascites: results of a Markov Model incorporating individual patient-level meta-analysis and nationally representative cost data. J Vasc Interv Radiol,2018,29(12):1705-1712.
[19] Dembinski J,Aranovich D,Banz V,et al.Surgical technique for placement of the automated low flow ascites pump (Alfapump).Langenbecks Arch Surg,2020,.
[20] Bereau C,Adebayo D,Chalret de Rieu M,et al.Alfapump system vs. large volume paracentesis for refractory ascites: A multicenter randomized controlled study.J Hepatol,2017,67(5):940-949.
[21] Stimimann G,Berg T,Spahr L,et al.Treatment of refractory ascites with an automated low-flow ascites pump in patients with cirrhosis.Aliment Pharnacol Ther,2017,46(10):981-991.
[22] Solbach P,Honer Zu Siederdissen C,Wellhoner F,et al.Automated low-flow ascites pump in a real-world setting: complications and outcomes.Eur J Gastroenterol Hepatol,2018,30(9):1082-1089.
[23] Lepida A,Marot A,Trepo E,et al.Systematic review with meta-analysis: automated low-flow ascites pump therapy for refractory ascites.Aliment Pharnacol Ther,2019,50(9):978-987.
[24] Iwasa M,Ishihara T,Kato M,et al.Cell-free and concentrated ascites reinfusion therapy for refractory ascites in cirrhosis in post-marketing surveillance and the role of tolvaptan.Intern Med,2019,58(21):3069-3075.
[25] Hanafusa N,Isoai A,Ishihara T,et al. Safety and efficacy of cell-free and concentrated ascites reinfusion therapy(CART) in refractory ascites: Post-marketing surveillance results.PLoS One,2017,12(5):A25163.
[26] Ito T,Hanafusa N.CART: Cell-free and concentrated ascites reinfusion therapy against malignancy-related ascites.Transfus Apher Sci,2017,56(5):703-707.
[27] Shimizu S,Chira M,Nakano R,et al.Management of refractory ascites for liver transplant candidates:A novel cell-free and concentrated ascites reinfusion therapy.Transplant Proc,2019,51(8):2740-2744.
[28] Yamada Y,Inui K,Hara Y,et al.Verification of serum albumin elevating effect of cell-free and concentrated ascites reinfusion therapy for ascites patients: a retrospective controlled cohort study.Sci Rep,2019,9(1):10195.
[29] Kasztelan-Szczerbinska B,Cichoz-Lach H.Refractory ascites—the contemporary view on pathogenesis and therapy.Peer J,2019,.
[30] 黄丽雯,刘黎,周健.干细胞移植治疗肝硬化顽固性腹水的疗效观察.胃肠病学与肝病学杂志,2011,34(3):237-239.