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Embolization of spontaneous portosystemic shunt for cirrhotic patients with portal hypertension: a review of current status
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摘要:
自发性门体分流(SPSS)在临床上并未得到足够重视,其在肝硬化患者中的发生率达38%~40%,并且在46%~70%的顽固性脑病患者中可见。SPSS封堵可能是治疗肝硬化顽固性脑病的一种安全且有效的手段。经颈静脉肝内门体分流术(TIPS)在预防和治疗门静脉高压并发症中的作用已经得到证实,对于肝硬化门静脉高压伴食管胃底静脉曲张破裂出血且可见SPSS形成的患者,行TIPS降低门静脉压力预防曲张静脉再出血是必要的,同时联合SPSS封堵可能会降低TIPS的术后并发症,更大程度发挥TIPS优势使患者最大程度获益。目前,仍需要大量的随机对照试验来进一步证实。
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关键词:
- 肝硬化 /
- 高血压,门静脉 /
- 自发性门体分流 /
- 门体分流术,经颈内静脉肝内 /
- 综述
Abstract:Spontaneous portosystemic shunt( SPSS) has not yet drawn enough attention. The incidence of SPSS in cirrhotic patients is 38%-40%,and 46%-70% of cirrhotic patients with refractory encephalopathy show SPSS. Embolization of SPSS may be a safe and effective method for the treatment of refractory encephalopathy in patients with cirrhosis. The critical role of transjugular intrahepatic portosystemic shunt( TIPS) in the prevention and treatment of the complications of portal hypertension has been demonstrated. To further reduce portal pressure and prevent gastroesophageal variceal rebleeding,TIPS is essential for the treatment of cirrhotic patients with SPSS. Meanwhile,TIPS with SPSS embolization may reduce the post-TIPS complications,and the patients may benefit more from TIPS. Prospective randomized controlled trials are warranted to further confirm these findings.
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