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顽固性腹腔积液是肝硬化终末期表现,病死率高,预后差,笔者复习国内外相关文献并结合多年临床经验,介绍了肝硬化顽固性腹腔积液的定义详解、形成机制、治疗原则,并从利尿剂治疗、提高机体对利尿剂敏感性的治疗、腹腔穿刺放液、自体腹腔积液浓缩回输、门脉高压治疗及自体骨髓干细胞移植治疗等方面阐述了肝硬化顽固性腹腔积液的内科治疗方法。总体来讲,肝硬化顽固性腹腔积液内科治疗效果有限,最终需考虑肝移植。新型利尿剂,如Vaptan类药物的研发和自体骨髓干细胞移植治疗具有较好的前景,有望成为治疗顽固性腹腔积液的较好的治疗手段,但需大规模临床研究证实。
Stubborn peritoneal effusion is the performance of end-stage liver cirrhosis, high mortality and poor prognosis, the author review the relevant literature at home and abroad and combined with many years of clinical experience, introduced the definition of cirrhosis refractory ascites fluid definition, formation mechanism, treatment principle, And from the diuretic therapy to improve the body’s sensitivity to diuretic therapy, peritoneal puncture and discharge, autologous abdominal effusion concentration and transfusion, portal hypertension and autologous bone marrow stem cell transplantation and other aspects of liver cirrhosis refractory ascites Medical treatment. In general, cirrhotic patients with intractable ascites medical treatment is limited, and ultimately need to consider liver transplantation. The development of new diuretics, such as Vaptan, and autologous bone marrow stem cell transplantation have a good prospect and are expected to be a good treatment for intractable ascites, but confirmed by large-scale clinical studies.