|
TIPS治疗肝硬化门静脉高压及其并发症的研究现状
|
Abstract:
肝硬化门静脉高压的临床主要表现为腹水、食管胃静脉曲张(gastroesophageal varices, GOV)、食管胃静脉曲张破裂出血(esophagogastric variceal bleeding, EVB)和肝性脑病等。经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt, TIPS)是经颈静脉入路,通过在肝静脉与门静脉之间的肝实质内建立分流道,从结构上显著降低门静脉阻力,治疗门静脉高压相关并发症的微创介入技术。本文综合近年来国内外关于TIPS治疗肝硬化门静脉高压的最新研究进展。阐述了目前TIPS治疗的适应症、禁忌症、并发症及发展展望。
The clinical manifestations of portal hypertension in cirrhotic patients were ascites, gastroesopha-geal varices (GOV), esophagogastric variceal bleeding (EVB) and hepatic encephalopathy, etc. Transjugular intrahepatic portosystemic shunt (TIPS) is a transjugular approach that significantly reduces portal resistance structurally by establishing shunt in the hepatic parenchyma between the hepatic vein and the portal vein. Minimally invasive interventional techniques for the treatment of portal hypertension related complications. In this paper, the latest research progress of TIPS in the treatment of portal hypertension in cirrhosis is summarized. The indications, contraindications, complications and development prospects of TIPS therapy were described.
[1] | Ginès, P., Krag, A., Abraldes, J.G., et al. (2021) Liver Cirrhosis. The Lancet, 398, 1359-1376.
https://doi.org/10.1016/S0140-6736(21)01374-X |
[2] | 徐小元, 丁惠国, 李文刚, 等. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425. |
[3] | 徐小元, 丁惠国, 贾继东, 等. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 中国肝脏病杂志(电子版), 2016, 8(1): 1-18. |
[4] | R?sch, J., Hanafee, W.N. and Snow, H. (1969) Transjugular Portal Venography and Radiologic Portacaval Shunt: An Experimental Study. Radiology, 92, 1112-1114. https://doi.org/10.1148/92.5.1112 |
[5] | Buechter, M., Manka, P., Gerken, G., et al. (2018) Transjugular Intrahepatic Portosystemic Shunt in Patients with Portal Hypertension: Patency Depends on Coverage and Interventionalist’s Experi-ence. Digestive Diseases, 36, 218-227.
https://doi.org/10.1159/000486030 |
[6] | Garcia-Tsao, G. and Bosch, J. (2010) Management of Varices and Variceal Hemorrhage in Cirrhosis. New England Journal of Medicine, 362, 823-832. https://doi.org/10.1056/NEJMra0901512 |
[7] | Qi, X., Jia, J., Bai, M., et al. (2015) Transjugular Intrahepatic Por-tosystemic Shunt for Acute Variceal Bleeding. Journal of Clinical Gastroenterology, 49, 495-505. https://doi.org/10.1097/MCG.0000000000000205 |
[8] | De Franchis, R. (2015) Expanding Consensus in Portal Hypertension: Report of the Baveno VI Consensus Workshop: Stratifying Risk and Individualizing Care for Portal Hy-pertension. Journal of Hepatology, 63, 743-752.
https://doi.org/10.1016/j.jhep.2015.05.022 |
[9] | García-Pagán, J.C., Caca, K., Bureau, C., et al. (2010) Early Use of TIPS in Patients with Cirrhosis and Variceal Bleeding. New England Journal of Medicine, 362, 2370-2379. https://doi.org/10.1056/NEJMoa0910102 |
[10] | Lv, Y., Zuo, L., Zhu, X., et al. (2019) Identifying Optimal Candi-dates for Early TIPS among Patients with Cirrhosis and Acute Variceal Bleeding: A Multicentre Observational Study. Gut, 68, 1297-1310.
https://doi.org/10.1136/gutjnl-2018-317057 |
[11] | Bosch, J. and García-Pagán, J.C. (2003) Prevention of Variceal Rebleeding. The Lancet, 361, 952-954.
https://doi.org/10.1016/S0140-6736(03)12778-X |
[12] | Albillos, A. and Tejedor, M. (2014) Secondary Prophylaxis for Esophageal Variceal Bleeding. Clinics in Liver Disease, 18, 359-370. https://doi.org/10.1016/j.cld.2014.01.007 |
[13] | Angeli, P., Bernardi, M., Villanueva, C., et al. (2018) EASL Clinical Practice Guidelines for the Management of Patients with Decompensated Cirrhosis. Journal of Hepatology, 69, 406-460. https://doi.org/10.1016/j.jhep.2018.03.024 |
[14] | Holster, I.L., Tjwa, E.T., Moelker, A., et al. (2016) Covered Transjugular Intrahepatic Portosystemic Shunt versus Endoscopic Therapy+ β‐Blocker for Prevention of Variceal Re-bleeding. Hepatology, 63, 581-589.
https://doi.org/10.1002/hep.28318 |
[15] | Lv, Y., Qi, X., He, C., et al. (2018) Covered TIPS versus Endoscopic Band Ligation plus Propranolol for the Prevention of Variceal Rebleeding in Cirrhotic Patients with Portal Vein Thrombosis: A Randomised Controlled Trial. Gut, 67, 2156-2168. https://doi.org/10.1136/gutjnl-2017-314634 |
[16] | Gordon, F.D. (2012) Ascites. Clinics in Liver Disease, 16, 285-299. https://doi.org/10.1016/j.cld.2012.03.004 |
[17] | 徐小元, 丁惠国, 李文刚, 等. 肝硬化腹水及相关并发症的诊疗指南[J]. 临床肝胆病杂志, 2017, 33(10): 1847-1863. |
[18] | Salerno, F., Guevara, M., Bernardi, M., et al. (2010) Refractory Ascites: Pathogenesis, Definition and Therapy of a Severe Complication in Patients with Cirrhosis. Liver International, 30, 937-947.
https://doi.org/10.1111/j.1478-3231.2010.02272.x |
[19] | Bureau, C., Thabut, D., Oberti, F., et al. (2017) Transjugu-lar Intrahepatic Portosystemic Shunts with Covered Stents Increase Transplant-Free Survival of Patients with Cirrhosis and Recurrent Ascites. Gastroenterology, 152, 157-163.
https://doi.org/10.1053/j.gastro.2016.09.016 |
[20] | De Franchis, R., Bosch, J., Garcia-Tsao, G., et al. (2022) Baveno VII-Renewing Consensus in Portal Hypertension. Journal of Hepatology, 76, 959-974. https://doi.org/10.1016/j.jhep.2021.12.022 |
[21] | D’amico, G., Luca, A., Morabito, A., et al. (2005) Uncovered Transjugular Intrahepatic Portosystemic Shunt for Refractory Ascites: A Meta-Analysis. Gastroenterology, 129, 1282-1293. https://doi.org/10.1053/j.gastro.2005.07.031 |
[22] | R?ssle, M. and Gerbes, A.L. (2010) TIPS for the Treatment of Refractory Ascites, Hepatorenal Syndrome and Hepatic hydrothorax: A Critical Update. Gut, 59, 988-1000. https://doi.org/10.1136/gut.2009.193227 |
[23] | 陈斌, 范文哲, 向贤宏, 等. 美国肝病研究学会(AASLD)实践指南: 经颈静脉肝内门体分流术(TIPS)在治疗门脉高压症中的作用[J]. 影像诊断与介入放射学, 2010, 19(4): 242-249. |
[24] | 陈辉, 吕勇, 王秋和, 等. 经颈静脉肝内门体分流术专家共识[J]. 临床肝胆病杂志, 2017, 33(7): 1218-1228. |
[25] | Dhanasekaran, R., West, J.K., Gonzales, P.C., et al. (2010) Transjugular Intrahepatic Portosystemic Shunt for Symptomatic Refractory Hepatic Hydrothorax in Patients with Cirrhosis. Official Journal of the American Col-lege of Gastroenterology ACG, 105, 635-641. https://doi.org/10.1038/ajg.2009.634 |
[26] | 梁家琦, 刘汶. 肝肾综合征的中西医结合诊治[J]. 临床肝胆病杂志, 2022, 38(9): 1974-1979. |
[27] | Wong, F. (2012) Recent Advances in Our Understanding of Hepatorenal Syndrome. Nature Reviews Gastroenterology & Hepatology, 9, 382-391. https://doi.org/10.1038/nrgastro.2012.96 |
[28] | Angeli, P., Ginès, P., Wong, F., et al. (2015) Diagnosis and Man-agement of Acute Kidney Injury in Patients with Cirrhosis: Revised Consensus Recommendations of the International Club of Ascites. Gut, 64, 531-537.
https://doi.org/10.1136/gutjnl-2014-308874 |
[29] | Ginès, P., Cárdenas, A., Arroyo, V., et al. (2004) Management of Cirrhosis and Ascites. New England Journal of Medicine, 350, 1646-1654. https://doi.org/10.1056/NEJMra035021 |
[30] | Wong, F., Pantea, L. and Sniderman, K. (2004) Midodrine, Octreotide, Albumin, and TIPS in Selected Patients with Cirrhosis and Type 1 Hepatorenal Syndrome. Hepatology, 40, 55-64. https://doi.org/10.1002/hep.20262 |
[31] | Brensing, K., Textor, J., Perz, J., et al. (2000) Long Term Outcome after Transjugular Intrahepatic Portosystemic Stent-Shunt in Non-Transplant Cirrhotics with Hepatorenal Syndrome: A Phase II Study. Gut, 47, 288-295.
https://doi.org/10.1136/gut.47.2.288 |
[32] | Luca, A., Miraglia, R., Caruso, S., et al. (2011) Short- and Long-Term Effects of the Transjugular Intrahepatic Portosystemic Shunt on Portal Vein Thrombosis in Patients with Cirrhosis. Gut, 60, 846-852.
https://doi.org/10.1136/gut.2010.228023 |
[33] | 曹家伟, 丁鹏绪, 段峰, 等. 中国门静脉高压经颈静脉肝内门体分流术临床实践指南(2019年版) [J]. 临床肝胆病杂志, 2019, 35(12): 2694-2699. |
[34] | Fagiuoli, S., Bruno, R., Venon, W.D., et al. (2017) Consensus Conference on TIPS Management: Techniques, Indications, Contraindications. Digestive and Liver Disease, 49, 121-137. https://doi.org/10.1016/j.dld.2016.10.011 |
[35] | Perarnau, J.M., Le Gouge, A., Nicolas, C., et al. (2014) Covered vs. Uncovered Stents for Transjugular Intrahepatic Portosystemic Shunt: A Randomized Controlled Trial. Journal of Hepatology, 60, 962-968.
https://doi.org/10.1016/j.jhep.2014.01.015 |
[36] | Yang, Z., Han, G., Wu, Q., et al. (2010) Patency and Clinical Out-comes of Transjugular Intrahepatic Portosystemic Shunt with Polytetrafluoroethylene‐Covered Stents versus Bare Stents: A Meta-Analysis. Journal of Gastroenterology and Hepatology, 25, 1718-1725. https://doi.org/10.1111/j.1440-1746.2010.06400.x |
[37] | Bai, M., He, C.-Y., Qi, X.-S., et al. (2014) Shunting Branch of Portal Vein and Stent Position Predict Survival after Transjugular Intrahepatic Portosystemic Shunt. World Journal of Gastroenterology: WJG, 20, 774.
https://doi.org/10.3748/wjg.v20.i3.774 |
[38] | Vilstrup, H., Amodio, P., Bajaj, J., et al. (2014) Hepatic Encephalopa-thy in Chronic Liver Disease: 2014 Practice Guideline by AASLD and EASL. Hepatology, 60, 715-735. https://doi.org/10.1002/hep.27210 |
[39] | R?ssle, M. (2013) TIPS: 25 Years Later. Journal of Hepatology, 59, 1081-1093.
https://doi.org/10.1016/j.jhep.2013.06.014 |
[40] | Bai, M., Qi, X., Yang, Z., et al. (2011) Predictors of Hepatic En-cephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Cirrhotic Patients: A Systematic Review. Journal of Gastroenterology and Hepatology, 26, 943-951.
https://doi.org/10.1111/j.1440-1746.2011.06663.x |