摘要
经颈静脉肝内门体分流术(TIPS)是经颈静脉途径在肝静脉与门静脉之间穿刺建立门体分流通道以此来降低门静脉压力,从而控制急性食管胃静脉曲张出血(EGVB)。EGVB的预后在过去几十年有了显著的改善,目前内镜下套扎联合药物治疗被推荐为一线治疗方案。过去十年EGVB管理的最新进展和研究聚焦在相对较新的“early”或“pre-emptive”TIPS概念,即在标准治疗失败风险较高的EGVB患者中,推荐早期TIPS(入院72 h内,理想情况下24 h内)治疗。本文简要介绍早期TIPS对控制出血、病死率以及肝性脑病的影响,早期TIPS适用的高危人群、干预的时机及成本效益,早期TIPS在真实世界中的应用以及国际指南和共识对早期TIPS的推荐。
Transjugular intrahepatic portosystemic shunt(TIPS)is a procedure to establish a portosystemic shunt between the hepatic vein and the portal vein via the jugular approach,so as to reduce portal venous pressure and control acute esophagogastric variceal bleeding(EGVB).The prognosis of EGVB has been improved significantly over the past few decades,and endoscopic variceal ligation combined with drug therapy is now recommended as the first-line treatment regimen for this disease.The latest research advances in the management of EGVB over the past decade have focused on the relatively new concept of“early”or“pre-emptive”TIPS,that is to say,early TIPS(within 72 hours after admission,ideally within 24 hours)is recommended for patients with EGVB who are at a relatively high risk of failure in standard treatment.This article briefly introduces the effect of early TIPS on controlling bleeding,mortality rate,and hepatic encephalopathy,the high-risk population for early TIPS,timing of intervention,cost effectiveness,the applications of early TIPS in a real-world setting,and recommendations for early TIPS in international guidelines and consensus statements.
作者
王泽
黄金涛
仲斌演
沈健
朱晓黎
WANG Ze;HUANG Jintao;ZHONG Binyan;SHEN Jian;ZHU Xiaoli(Department of Interventional Radiology,The First Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215000,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2023年第7期1513-1522,共10页
Journal of Clinical Hepatology
基金
江苏省社会发展面上项目(BE20221648)
苏州市民生科技项目(SS202059)。
关键词
门体分流术
经颈静脉肝内
食管和胃静脉曲张
出血
Portasystemic Shunt,Transjugular Intrahepatic
Esophageal and Gastric Varices
Hemorrhage
