Causes of hepatocellular carcinoma ascites: 1. Compression by cancer or obstruction by cancer embolus obstructs blood circulation in portal vein or hepatic vein and increases vascular pressure. If the intravascular pressure is too high, it will cause congestion of venous vascular bed and increase of hydrostatic pressure, resulting in imbalance of fluid exchange inside and outside the vessels. The reflux of tissue fluid is obstructed and leaks into the abdominal cavity to form ascites. 2.The cancer infiltrates the peritoneum or implants in the peritoneal cavity, which can directly damage the capillaries of the peritoneum. This leads to the increase of capillary permeability, which causes a large amount of fluid and protein to enter the peritoneal cavity to form ascites. If liver cancer nodules rupture and bleed spontaneously and break into the abdominal cavity, ascites can also be produced. 3. Hypoproteinemia is often caused by malnutrition and liver function damage of different degrees in patients with liver cancer. If the plasma protein is as low as 25-30g/L, the plasma osmotic pressure will decrease, resulting in extravasation of plasma and formation of ascites. 4.Increased portal vein pressure can cause tissue fluid reflux to be obstructed and leak into the abdominal cavity to form ascites. This is mainly because patients with liver cancer are often combined with portal vein cancer embolism and cirrhosis, which can increase portal vein pressure. Once ascites appears in liver cancer patients, it is difficult to control, which seriously affects the survival quality of patients. However, it does not mean that it has no treatment value, but should still be treated actively to improve the quality of survival and prolong the survival time, so as to create conditions for the best treatment plan. For patients with hepatocellular carcinoma complicated with ascites, first of all, the primary tumor lesions in liver should be treated actively. Whether the intrahepatic tumor foci can be controlled or not directly affects the increase or decrease of the amount of ascites and the progress rate of the disease. The treatment of hepatocellular carcinoma depends on whether the patient can undergo surgery, radiotherapy, chemotherapy, mesotherapy, etc. However, when using these methods, it should be noted that: when the amount of ascites is small or at the early stage of the disease, and the patient’s liver function is not obviously damaged, surgery, radiotherapy, chemotherapy, mesotherapy can be applied as appropriate, but the plan with less damage to liver function should still be chosen, or appropriate liver-protective treatment should be given in time after the treatment; when the ascites is medium or above, the liver function is injured. In the case of moderate ascites, liver function injury is obvious, such as surgery, radiotherapy, chemotherapy, trans-portal infusion chemotherapy and other treatments, in principle, are not used, a few do have therapeutic value, it is best to make the ascites recede or significantly reduce, but should be used with caution to prevent aggravating the damage to liver function. Transdermal drug injection, transhepatic artery infusion chemotherapy and other methods that are less harmful to liver function can be used as appropriate, and appropriate liver-protective treatment should be given at the same time. Symptomatic supportive therapy: Patients with hepatocellular carcinoma who develop ascites must actively control the growth of ascites to minimize the pain of patients and create opportunities for complete cure of hepatocellular carcinoma. 1. Discharging ascites can rapidly reduce intra-abdominal pressure, relieve the compression symptoms of heart, lung, kidney and gastrointestinal tract, and alleviate patients’ pain. However, such relief is only temporary, and ascites will grow rapidly within a short period of time. Repeated discharge of ascites will lead to large loss of body fluid and protein, water-electrolyte disorder, upright hypotension, inducing liver coma and other serious consequences, therefore, discharge of ascites cannot be the first choice of treatment. For individual patients, if ascites affects respiratory function and cardiac and renal functions, abdominal puncture can be considered to discharge ascites to reduce intra-abdominal pressure, increase renal blood flow and temporarily improve respiratory function and cardiac and renal functions. Proper supplementation of albumin after discharge of ascites. 2, intraperitoneal chemotherapy after appropriate discharge of ascites, intraperitoneal injection of anti-tumor drugs can reduce the generation of ascites, so that the liver and intraperitoneal drugs to maintain a very high level, while the toxic reactions than the systemic use of the same drugs is much smaller. It has been reported that when 5-FU is injected intraperitoneally, the drug concentration in portal blood is 10-20 times higher than that after peripheral intravenous administration. Commonly used drugs include cisplatin, carboplatin, 5-fluorouracil, adriamycin, etc. 3, limit the intake of water and sodium currently advocate ascites patients do not need to completely prohibit the intake of sodium, the daily sodium intake of mild cases not more than 1g, serious cases not more than 0.5g, and appropriate to limit the intake of water. 4, increase water, sodium discharge can use diuretics, it is appropriate to use a variety of alternate or combined use, and pay attention to the electrolyte balance. In mild cases, oral potassium excreting diuretics can be used, such as dihydrocodone, chlorothiazide, tachyphylaxis. Surgical treatment: abdominal a jugular vein shunt: belongs to endovascular dilatation, which is a method of returning ascites to the blood circulation by using the pressure difference between the abdominal cavity and the superior vena cava during respiration. The method uses a drainage tube with a one-way valve that is buried under the skin of the thoracoabdominal wall, with one section inserted into the abdominal cavity and the other into the superior vena cava via the external jugular vein. During inspiration, the transverse septum moves down and the intra-abdominal pressure rises above the superior vena cava pressure, and the ascites is pressurized into the blood circulation through the drainage tube. This procedure is simple, less invasive and can be tolerated by patients with poor general condition. It is suitable for the treatment of large amount of ascites causing dyspnea, hepatorenal syndrome and intractable ascites when it is clear that the ascites is not infected and no cancer cells are found.