Advances in transjugular intrahepatic portosystemic shunt and its application in treatment of cirrhotic portal hypertension
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摘要:
近年来,随着基础研究及临床应用的进步,经颈静脉肝内门体分流术(TIPS)的成功率明显提高,支架再狭窄率及术后肝性脑病的发生率亦得到控制。结合笔者临床实践及国内外大会热点,就TIPS相关技术进展及其在肝硬化中的应用进行介绍,主要包括TIPS穿刺辅助技术、TIPS支架、TIPS相关肝性脑病及防治以及TIPS适应证和禁忌证、TIPS在肝硬化中解决的问题、肝硬化食管胃底静脉曲张破裂出血治疗中TIPS相对于其他治疗方法的优缺点。以期为TIPS更好的发展作一点贡献,让更多肝硬化患者获益。
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关键词:
- 肝硬化 /
- 门静脉高压 /
- 门体分流术,经颈静脉肝内 /
- 食管胃底静脉曲张
Abstract:In recent years,with the development in basic research and clinical application,the success rate of transjugular intrahepatic portosystemic shunt( TIPS) has been increased significantly,and stent restenosis rate and the incidence of postoperative hepatic encephalopathy have been controlled. With reference to the authors' clinical practice and hot topics of conferences at home and abroad,this article introduces the advances in TIPS- related techniques and their application in liver cirrhosis,including TIPS puncture technique,TIPS stent,TIPS- related hepatic encephalopathy and its prevention and treatment,TIPS indications and contraindications,the issues solved by TIPS in liver cirrhosis,and the advantages and disadvantages of TIPS in the treatment of esophagogastric variceal bleeding compared with other therapeutic methods,in order to make contributions to the development of TIPS and bring more benefits to patients with liver cirrhosis.
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[1]ZHUGE YZ.Transjugular intrahepatic portosystemic shunt for treatment of portal hypertension-advancing with exploration[J].Chin J Clin Res,2011,24(8):657-658.(in Chinese)诸葛宇征.经颈静脉肝内门体分流术治疗门静脉高压症——在探索中前行[J].中国临床研究,2011,24(8):657-658. [2]RICHTER GM,NOELDGE G,PALMAZ JC,et al.The transjugular intrahepatic portosystemic stent-shunt(TIPSS):results of a pilot study[J].Cardiovasc Inter Rad,1990,13(3):200-207. [3]MERRIMAN RB,TRAN TT.AASLD practice guidelines:the past,the present and the future[J].Hepatology,2016,63(1):31-34. [4]RAPPOSELLI D.Highlights from AASLD 2013[J].Gastroenterol Hepatol(N Y),2013,9(12):833-834. [5]WU X,DING W,CAO J,et al.Clinical outcome using the fluency stent graft for transjugular intrahepatic portosystemic shunt in patients with portal hypertension[J].Am Surg,2013,79(3):305-312. [6]MERMUYS K,MALEUX G,HEYE S,et al.Use of the Viatorr expanded polytetrafluoroethylene-covered stent-graft for transjugular intrahepatic portosystemic shunt creation in children:initial clinical experience[J].Cardiovasc Inter Rad,2008,31(Suppl 2):s192-s196. [7]MA QY,ZHUGE YZ,HE QB,et al.Effect of transjugular intrahepatic portosystemic shunt with 8-mm stents on portal vein hemodynamics[J].Chin J Dig,2013,33(8):550-551.(in Chinese)马千云,诸葛宇征,贺奇彬,等.采用8 mm内径支架经颈静脉肝内门腔静脉分流对门静脉血流动力学的影响[J].中华消化杂志,2013,33(8):550-551. [8]ROSCH J.Development of transjugular intrahepatic portosystemic shunt[J].J Vasc Interv Radiol,2015,26(2):220-222. [9]MIRAGLIA R,MARUZZELLI L,LUCA A.Recanalization of occlusive transjugular intrahepatic portosystemic shunts inaccessible to the standard transvenous approach[J].Diagn Interv Radiol,2013,19(1):61-65. [10]TSAUO J,LI X.Viatorr TIPS endoprosthesis versus generic expanded polytetrafluoroethylene-covered stent-grafts[J].AJR Am J Roentgenol,2015,205(4):w463. [11]COOKSON DT,ZAMAN Z,GORDON-SMITH J,et al.Management of transjugular intrahepatic portosystemic shunt(TIPS)-associated refractory hepatic encephalopathy by shunt reduction using the parallel technique:outcomes of a retrospective case series[J].Cardiovasc Inter Rad,2011,34(1):92-99. [12]KRISHNAMOORTHY TL,TANEJA M,CHANG PE.Symptomatic hepatic hydrothorax successfully treated with transjugular intrahepatic portosystemic shunt(TIPS)-role of titration of portosystemic gradient reduction to avoid post-TIPS encephalopathy[J].Clin Case Rep,2014,2(3):93-97. [13]CAI W,ZHUGE YZ,ZHANG JW,et al.Safety and clinical efficacy of TIPS with various stents for treatment of cirrhosis with esophageal gastric varices bleeding[J].Chin J Hepatol,2015,23(4):258-264.(in Chinese)蔡炜,诸葛宇征,张建武,等.不同支架经颈静脉肝内门体静脉分流术治疗肝硬化食管胃静脉曲张出血的安全性和疗效研究[J].中华肝脏病杂志,2015,23(4):258-264. [14]HIDAJAT N,KREUSCHNER M,ROTTGEN R,et al.Placement of transjugular intrahepatic portosystemic shunt via the left hepatic vein under sonographic guidance in a patient with right hemihepatectomy[J].Acta Radiol,2003,44(4):363-365. [15]CHEN L,XIAO T,CHEN W,et al.Outcomes of transjugular intrahepatic portosystemic shunt through the left branch vs.the right branch of the portal vein in advanced cirrhosis:a randomized trial[J].Liver Int,2009,29(7):1101-1109. [16]AHN SY,PARKS Y,TAKW Y,et al.Prospective validation of Baveno V definitions and criteria for failure to control bleeding in portal hypertension[J].Hepatology,2015,61(3):1033-1040. [17]de FRANCHIS R,BAVENO VI/FACULTY.Expanding consensus in portal hypertension:report of the Baveno VI Consensus Workshop:stratifying risk and individualizing care for portal hypertension[J].J Hepatol,2015,63(3):743-752. [18]SHARARA AI,ROCKEY DC.Gastroesophageal variceal hemorrhage[J].N Engl J Med,2001,345(9):669-681. [19]GARCIA-TSAO G,BOSCH J.Management of varices and variceal hemorrhage in cirrhosis[J].N Engl J Med,2010,362(9):823-832. [20]ROSSLE M,DEIBERT P,HAAG K,et al.Randomised trial of transjugular-intrahepatic-portosystemic shunt versus endoscopy plus propranolol for prevention of variceal rebleeding[J].Lancet,1997,349(9058):1043-1049. [21] GARCIA-PAGAN JC,CACA K,BUREAU C,et al.Early use of TIPS in patients with cirrhosis and variceal bleeding[J].N Engl J Med,2010,362(25):2370-2379. [22]POMIER-LAYRARGUES G,VILLENEUVE JP,DESCHENES M,et al.Transjugular intrahepatic portosystemic shunt(TIPS)versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis:a randomised trial[J].Gut,2001,48(3):390-396.
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