zdorПроблемы здоровья и экологииHealth and Ecology Issues2220-09672708-6011Gomel State Medical University10.51523/2708-6011.2012-9-3-6zdor-1277Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESТАКТИКА ВЕДЕНИЯ АСЦИТА У ПАЦИЕНТОВ С ЦИРРОЗОМ ПЕЧЕНИMANAGEMENT OF ASCITES IN CIRRHOSISМалаеваЕ. Г.MalaevaE. G.noemail@neicon.ruГомельский государственный медицинский университетGomel State Medical University201228092012032835Copyright © Малаева Е.Г., 20122012Малаева Е.Г.Malaeva E.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.gsmu.by/jour/article/view/1277

Асцит является распространенным осложнением цирроза печени, ассоциированным с неблагоприятным прогнозом. Лечение асцита предусматривает ограничение потребления натрия и разумное использование диуретиков. Тактикой ведения пациентов с рефрактерным асцитом является выполнение лечебного объемного парацентеза, трансъюгулярного портосистемного шунтирования, трансплантации печени. У пациентов с асцитом потенциально новыми лечебными возможностями обладают вазоконстрикторы, антагонисты V2 рецепторов вазопрессина, наложение перитонео-мочепузырного шунта.

Ascites is a common complication of liver cirrhosis associated with a poor prognosis. The treatment of ascites requires dietary sodium restriction and the judicious use of diuretics. Management of refractory ascites in cirrhosis requires treatments of repeat largevolumeparacentesis (LVP) or the insertion of a transjugular intrahepatic portosystemic shunt (TIPS), and assessment for liver transplantation. Potential new treatment options for ascites include the use of various vasoconstrictors, vasopressin V2 receptor antagonists, or the insertion of a peritoneo-vesical shunt.

асцитцирроз печенидиуретикивазоконстрикторылечебный объемный парацентезтрансплантация печениascitesliver cirrhosisdiureticsvasoconstrictorslargevolumeparacentesisliver transplantationReferencesWong, F. Management of ascites in cirrhosis / F. Wong // J. Gastroenterol. Hepatol. - 2012. -Vol. 27. -P. 11-20.Wong, F. Management of ascites in cirrhosis / F. Wong // J. Gastroenterol. Hepatol. - 2012. -Vol. 27. -P. 11-20.D’Amico, G. Natural history andprognostic indicators of survival in cirrhosis: a systematic review of118 studies / G. D’Amico, G. Garcia-Tsao, L. Pagliaro // J. Hepatol. - 2006. - Vol. 44. - Р. 217-231.D’Amico, G. Natural history andprognostic indicators of survival in cirrhosis: a systematic review of118 studies / G. D’Amico, G. Garcia-Tsao, L. Pagliaro // J. Hepatol. - 2006. - Vol. 44. - Р. 217-231.Natural history of patients hospitalized for management of cirrhotic ascites / R. Planas [et al.] // Clin. Gastroenterol. Hepatol. - 2006. - Vol. 4. - Р. 1385-1394.Natural history of patients hospitalized for management of cirrhotic ascites / R. Planas [et al.] // Clin. Gastroenterol. Hepatol. - 2006. - Vol. 4. - Р. 1385-1394.Guevara, M. Hepatorenal syndrome / M. Guevara, V. Arroyo // Expert Opin. Pharmacother. - 2011. - Vol. 12. - Р. 1405-1417.Guevara, M. Hepatorenal syndrome / M. Guevara, V. Arroyo // Expert Opin. Pharmacother. - 2011. - Vol. 12. - Р. 1405-1417.Cárdenas, A. Mechanisms of water and sodium retention in cirrhosis and the pathogenesis of ascites / A. Cárdenas, V. Arroyo // Best Pract Res Clin. Endocrinol. Metab. - 2003. - Vol. 17. - Р. 607-622.Cárdenas, A. Mechanisms of water and sodium retention in cirrhosis and the pathogenesis of ascites / A. Cárdenas, V. Arroyo // Best Pract Res Clin. Endocrinol. Metab. - 2003. - Vol. 17. - Р. 607-622.The management of ascites - report on the consensus conference of the International Ascites Club / K. P. Moore [et al.] // Hepatology. - 2003. - Vol. 38. - Р. 258-266.The management of ascites - report on the consensus conference of the International Ascites Club / K. P. Moore [et al.] // Hepatology. - 2003. - Vol. 38. - Р. 258-266.Refractory ascites, pathogenesis, definition, and therapy of a severe complication in cirrhotic patients / F. Salerno [et al.] // Liver Int. - 2010. - Vol. 30. - Р. 937-947.Refractory ascites, pathogenesis, definition, and therapy of a severe complication in cirrhotic patients / F. Salerno [et al.] // Liver Int. - 2010. - Vol. 30. - Р. 937-947.Runyon, B. A. AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis: an update / B. A. Runyon // Hepatology. - 2009. - Vol. 49. - Р. 2087-2107.Runyon, B. A. AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis: an update / B. A. Runyon // Hepatology. - 2009. - Vol. 49. - Р. 2087-2107.Leung, W. Medical management of ascites/ W. Leung, F. Wong // Expert Opin. Pharmacother. - 2011. - Vol. 12. - P. 1269-1283.Leung, W. Medical management of ascites/ W. Leung, F. Wong // Expert Opin. Pharmacother. - 2011. - Vol. 12. - P. 1269-1283.Wong, F. Drug insight: the role of albumin in the management ofchronic liver disease / F. Wong // Nat. Clin. Pract. Gastroenterol. Hepatol. - 2007. - Vol. 4. - Р. 43-51.Wong, F. Drug insight: the role of albumin in the management ofchronic liver disease / F. Wong // Nat. Clin. Pract. Gastroenterol. Hepatol. - 2007. - Vol. 4. - Р. 43-51.Long-term albumininfusion improves survival in patients with cirrhosis and ascites: anunblinded randomized trial / R. G. Romanelli [et al.] // World J. Gastroenterol. - 2006. - Vol. 12. - Р. 1403-1407.Long-term albumininfusion improves survival in patients with cirrhosis and ascites: anunblinded randomized trial / R. G. Romanelli [et al.] // World J. Gastroenterol. - 2006. - Vol. 12. - Р. 1403-1407.The effects of VPA-985, a vasopressin receptor antagonist, on water metabolism in patients with hyponatremia: a multi-center randomized placebo controlled trial / F. Wong [et al.] // Hepatology. - 2003. - Vol. 37. - Р. 182-191.The effects of VPA-985, a vasopressin receptor antagonist, on water metabolism in patients with hyponatremia: a multi-center randomized placebo controlled trial / F. Wong [et al.] // Hepatology. - 2003. - Vol. 37. - Р. 182-191.Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia / R. W. Schrier [et al.] // N. Engl. J. Med. - 2006. - Vol. 355. - Р. 2099-2112.Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia / R. W. Schrier [et al.] // N. Engl. J. Med. - 2006. - Vol. 355. - Р. 2099-2112.Ginès, P. Effects of Satavaptan, a selective vasopressin V2 receptor antagonist, on ascites and serum sodium concentration in patients with cirrhosis and hyponatremia / P. Ginès [et al.] // Hepatology. - 2008. - Vol. 48. - Р. 204-213.Ginès, P. Effects of Satavaptan, a selective vasopressin V2 receptor antagonist, on ascites and serum sodium concentration in patients with cirrhosis and hyponatremia / P. Ginès [et al.] // Hepatology. - 2008. - Vol. 48. - Р. 204-213.Satavaptan for the management of ascites in cirrhosis: efficacy and safety across the spectrum of ascites severity / F. Wong, [et al.] // Gut. - 2011 (in press).Satavaptan for the management of ascites in cirrhosis: efficacy and safety across the spectrum of ascites severity / F. Wong, [et al.] // Gut. - 2011 (in press).Effects of M0002, a novel V2 antagonist on sodium levels and weight gain affected by water accumulation in cirrhotic patients with ascites / F. Nevens [et al.] // J. Hepatol. - 2009. - Vol. 50. - Р. 76.Effects of M0002, a novel V2 antagonist on sodium levels and weight gain affected by water accumulation in cirrhotic patients with ascites / F. Nevens [et al.] // J. Hepatol. - 2009. - Vol. 50. - Р. 76.Colombato, L. The role of transjugular intrahepatic porto-systemicshunt (TIPS) in the management of portal hypertension / L. Colombato // J. Clin. Gastroenterol. - 2007. - Vol. 41. - Р. 344-351.Colombato, L. The role of transjugular intrahepatic porto-systemicshunt (TIPS) in the management of portal hypertension / L. Colombato // J. Clin. Gastroenterol. - 2007. - Vol. 41. - Р. 344-351.Transjugularintrahepatic portosystemic shunt for refractory ascites, ameta-analysis of individual patient data / F. Salerno [et al.] // Gastroenterology. - 2007. - Vol. 133. - Р. 825-834.Transjugularintrahepatic portosystemic shunt for refractory ascites, ameta-analysis of individual patient data / F. Salerno [et al.] // Gastroenterology. - 2007. - Vol. 133. - Р. 825-834.

The authors declare that there are no conflicts of interest present.