TIPS治疗肝硬化门脉高压急性静脉曲张出血:救命治疗还是一线治疗?

韩国宏; 祁兴顺; 樊代明

TIPS治疗肝硬化门脉高压急性静脉曲张出血:救命治疗还是一线治疗?

第四军医大学西京消化病医院消化介入科

详细信息

中图分类号: R575.2
计量
- 文章访问数: 389
- HTML全文浏览量: 23
- PDF下载量: 411
- 被引次数: 0
出版历程
- 出版日期: 2011-03-20

Transjugular intrahepatic portosystemic shunt for patients with cirrhosis and acute variceal bleeding:rescue or first-line therapy?

摘要

摘要: 美国肝脏病学会门静脉高压防治指南和TIPS治疗门脉高压指南均推荐TIPS应作为药物及内镜控制急性静脉曲张出血失败后的"救命"治疗。然而,虽然出血控制率较好,但病死率仍较高。最近,对肝功能不好的肝硬化急性静脉曲张出血患者的多中心随机对照研究显示,用覆膜支架早期TIPS与药物联合内镜比较,前者能显著减低出血控制失败率和延长生存率。当急性静脉出血发生在Child-Pugh B级或C级（≤13分）患者时,应将覆膜支架TIPS做为一线治疗,而非"救命"治疗。
- 门体分流术,经颈静脉肝内 /
- 食管和胃静脉曲张 /
- 胃肠出血 /
- 高血压,门静脉 /
- 肝硬化
Abstract: In the current American Association for the Study of Liver Disease Practice Guidelines, the use of transjugular intrahepatic portosystemic shunt (TIPS) to control variceal bleeding has largely been recommended for patients who require rescue therapy because hemostasis has not been achieved.TIPS is extremely effective in controlling bleeding, nevertheless, mortality at 6 weeks among patients treated with rescue TIPS for uncontrolled index bleeding is very high.Recently, the results of a multi-center randomized controlled study that compared early TIPS with optimal medical therapy in patients at high risk for rebleeding who were either in Child-Pugh class B with active bleeding at endoscopy or in Child-Pugh class C showed the benefit of early TIPS.Therefore, the early use of TIPS with an e-PTFE-covered stent as first-line therapy rather than as rescue treatment if rebleeding occurs in high-risk patients with Child-Pugh B or C disease.
- portosystemic shunt /
- transjugular intrahepatic /
- esophageal and gastric varices /
- gastrointestinal hemorrhage /
- hypertension

HTML全文

参考文献(19)

[1]Garcia-Tsao G, Bosch J.Management of varices and variceal hemorrhage in cirrhosis[J].N Engl J Med, 2010, 362 (9) :823-832.

[2]Rossle M, Richter GM, Noldge G, et al.Performance of an intrahepatic portocaval shunt (PCS) using a catheter technique-a case report[J].Hepatology, 1988, 8:1348A.

[3]Papatheodoridis GV, Goulis J, Leandro G, et al.Transjugular intrahepatic portosystemic shunt compared with endoscopic treatment for prevention of variceal rebleeding:a meta-analysis[J].Hepatology, 1999, 30 (3) :612-622.

[4]Luca A, D'Amico G, La Galla R, et al.TIPS for prevention of recurrent bleeding in patients with cirrhosis:meta-analysis of randomized clinical trials[J].Radiology, 1999, 212 (2) :411-421.

[5]Burroughs AK, Vangeli M.Transjugular intrahepatic portosystemic shunt versus endoscopic therapy:randomized trials for secondary prophylaxis of variceal bleeding:an updated meta-analysis[J].Scand J Gastroenterol, 2002, 37 (3) :249-252.

[6]Zheng M, Chen Y, Bai J, et al.Transjugular intrahepatic portosystemic shunt versus endscopic therapy in the secondary prophylaxis of variceal rebleeding in cirrhotic patients meta-analysis update[J].J Clin Gastroenterol, 2008, 42 (5) :507-516.

[7]Boyer TD, Haskal ZJ.The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension:update 2009[J].Hepatology, 2010, 51 (1) :306.

[8]Garcia-Tsao G, Sanyal AJ, Grace NG, et al.Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis[J].Hepatology, 2007, 46 (3) :922-938.

[9]Rossle M.TIPS:an update[J].Best Prac Res Clin Gastroenterol, 2004, 18 (1) :99-123.

[10]Riggio O, Ridola L, Lucidi S, et al.Emerging issue in the use of transjugular intrahepatic portosystemic shunt (TIPS) for the management of portal hypertension:time to update the guidelines?[J].Dig Liv Dis, 2010, 42 (7) :462-467.

[11]Afdhal NH, Curry MP.Early TIPS to improve survival in acute variceal bleeding[J].N Engl J Med, 2010, 362 (25) :2421-2422.

[12]Moitinho E, Escorsell A, Bandi J, et al.Prognostic value of early measurements of portal pressure in active variceal bleeding[J].Gastroenterology, 1999, 117 (3) :626-631.

[13]Moitinho E, Planas R, Baares R, et al.Multicenter randomized controlled trial comparing different schedules of somatostatin in the treatment of acute variceal bleeding[J].J Hepatol, 2001, 35 (6) :712-718.

[14]D'Amico G, De Franchis R.Upper digestive bleeding in cirrhosis.Post-therapeutic outcome and prognostic indictors[J].Hepatology, 2003, 38 (3) :599-612.

[15]Abraldes JG, Villanueva C, Baares R, et al.Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy[J].J Hepatol, 2008, 48 (2) :229-236.

[16]Monescillo A, Martinez-Lagares F, Ruiz-del-Arbol L, et al.Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding[J].Hepatology, 2004, 40 (4) :793-801.

[17]García-Pagán 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.

[18]Rossle M, Grandt D.Early Transjugular intrahepatic porto-systemic shunt in patients with cirrhosis and variceal bleeding[J].Hepatology, 2010, 52 (5) :1847-1849.

[19]Bureau C, Garcia-Pagan JC, Otal P, et al.Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS:results of a randomized study[J].Gastroenterology, 2004, 126 (2) :469-475.

施引文献

资源附件(0)

访问统计