Abstract
Ascites develops in patients with cirrhosis because of the development of portal hypertension in concert with splanchic vasodilatation, renal sodium retention, and active renal vasoconstriction. The quality of life (QOL) of patients with refractory ascites is markedly compromised, and these patients are frequently admitted to the hospital for recurrence of tense ascites, renal failure, infection, or other related morbidities. Approximately 50% of these patients die within 12 months. A number of approaches have been taken in the management of patients with refractory ascites, including peritoneovenous shunts (PVS), repeated large volume paracentesis (LVP), and transjugular intrahepatic portosystemic shunt (TIPS). In the TIPS groups, the percentage of patients who showed improvement in their ascites was 49% while in the LVP groups improvement was seen in 90% of patients. The average survival at 2 years of follow-up was 60% for patients allocated to TIPS and 15～30% for patients allocated to LVP or PVS, respectively. Several controlled studies have suggested that patients who underwent TIPS for refractory ascites experienced improved QOL.
