恶性腹腔积液的中医药治疗：研究现状与未来展望

Traditional Chinese Medicine for the Treatment of Malignant Ascites: Research Status and Future Prospects

摘要: 恶性腹腔积液(Malignant Ascites, MA)是晚期恶性肿瘤常见且严重的并发症，其发生多与腹膜受侵、淋巴回流受阻及低蛋白血症等因素相关。MA不仅引发腹胀、疼痛、呼吸困难等一系列症状，更预示着极差的预后，患者中位生存期仅1~4个月。现代医学治疗以对症支持为核心，包括利尿剂、腹腔穿刺引流及腹腔内灌注治疗等，虽能短暂控制症状，但普遍存在疗效不持久、复发率高及并发症风险等问题。中医药基于“臌胀”、“水证”等理论，构建了以“脾肾阳虚为本，气滞、血瘀、水停为标”为核心的辨证体系，治疗上强调扶正与祛邪并举，在控制腹水、改善生活质量方面显示出独特优势，并形成了中西医结合的综合治疗模式。本文系统梳理近年来MA的中西医病因病机、治疗策略及临床研究进展，旨在为优化临床实践提供参考。

Abstract: Malignant ascites (MA) is a common and serious complication of advanced malignant tumors, primarily associated with peritoneal invasion, lymphatic obstruction, and hypoproteinemia. It not only causes a series of symptoms such as abdominal distension, pain, and dyspnea but also indicates a poor prognosis, with a median survival of only 1 to 4 months. Modern medical management focuses on symptomatic support, including diuretics, therapeutic paracentesis, and intraperitoneal chemotherapy. While these measures can temporarily alleviate symptoms, they are often limited by short-lasting efficacy, high recurrence rates, and associated complications. Based on the theories of “tympanites” and “water syndrome”, traditional Chinese medicine (TCM) has established a syndrome differentiation system centered on “deficiency of spleen and kidney Yang as the root, and qi stagnation, blood stasis, and fluid retention as the manifestations”. This paper systematically reviews recent advances in the etiology, pathogenesis, therapeutic strategies, and clinical research on MA from the perspectives of both traditional Chinese and Western medicine, aiming to provide insights for optimizing clinical practice.