经颈静脉肝内门体静脉分流术治疗肝硬化门静脉高压共识意见

中华医学会消化病学分会消化介入学组

doi:10.3969/j.issn.1001-5256.2014.03.003

经颈静脉肝内门体静脉分流术治疗肝硬化门静脉高压共识意见

DOI: 10.3969/j.issn.1001-5256.2014.03.003

中华医学会消化病学分会消化介入学组

基金项目:

卫生公益性行业科研专项(201002015)；

详细信息

中图分类号: R575.21
计量
- 文章访问数: 3625
- HTML全文浏览量: 9
- PDF下载量: 1087
- 被引次数: 0
出版历程
- 出版日期: 2014-03-20

Consensus on transjugular intrahepatic portosystemic shunt for treatment of cirrhotic portal hypertension

Group of Gastrointestinal InterventionChinese Society of GastroenterologyChinese Medical Association;

Research funding:

摘要

摘要:
<正>门静脉高压症是肝硬化发展过程中的重要病理生理环节,也是肝硬化失代偿期的重要临床表现之一。经颈静脉肝内门体静脉分流术（transjugular intrahepatic portosystemic shunt,TIPS）通过在肝静脉与门静脉之间的肝实质内建立分流道,以微创的方式,从结构上显著降低门静脉阻力,是降低肝硬化患者门静脉压力的关键措施之一。选择恰当病例,可有效减少食管胃静脉曲张再出血和腹水复发等肝硬化并发症,改善肝硬化患者生活质量,减少或延缓对肝移植的需求[1-3]。TIPS应用于临床已有20余年,在经历了一系列观念、技术、器材和联合药物治疗的探索后,目前该技术的有效性和安
- 肝硬化 /
- 门静脉,高血压 /
- 门体分流术,经颈静脉肝内 /
- 指南
- liver cirrhosis /
- hypertension, portal /
- portasystemic shunt, transjugular intrahepatic /
- guidebooks

HTML全文

参考文献(50)

[1]HASKAL ZJ, MARTIN L, CARDELLA JF, et al.Quality improvement guidelines for transjugular intrahepatic portosystemic shunts[J].J Vasc Interv Radiol, 2003, 14 (9 Pt 2) :s265-s270.

[2]BOYER TD, HASKAL ZJ, American Association for the Study of Liver Diseases.The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension:update2009[J].Hepatology, 2010, 51 (1) :306.

[3]BONNEL AR, BUNCHORNTAVAKUL C, REDDY RK.Transjugular intrahepatic portosystemic shunt (TIPS) in liver transplant recipients[J].Liver Transpl, 2013, Oct 18.[Epub ahead of print]

[4]KALVA SP, SALAZAR GM, WALKER TG.Transjugular intrahepatic portosystemic shunt for acute variceal hemorrhage[J].Tech Vasc Interv Radiol, 2009, 12 (2) :92-101.

[5]BOSCH J, ABRALDES JG, GROSZMANN R.Current management of portal hypertension[J].J Hepatol, 2003, 38 (Suppl 1) :s54-s68.

[6] GARCA-PAGN 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.

[7]ZHENG M, CHEN Y, BAI J, et al.Transjugular intrahepatic portosystemic shunt versus endoscopic therapy in the secondary prophylaxis of variceal rebleeding in cirrhotic patients:meta-analysis update[J].J Clin Gastroenterol, 2008, 42 (5) :507-516.

[8]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.

[9]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.

[10]SALERNO F, BORRONI G, MOSER P, et al.Survival and prognostic factors of cirrhotic patients with ascites:a study of 134 outpatients[J].Am J Gastroenterol, 1993, 88 (4) :514-519.

[11]GUARDIOLA J, BALIELLAS C, XIOL X, et al.External validation of a prognostic model for predicting survival of cirrhotic patients with refractory ascites[J].Am J Gastroenterol, 2002, 97 (9) :2374-2378.

[12]MOREAU R, DELGUE P, PESSIONE F, et al.Clinical characteristics and outcome of patients with cirrhosis and refractory ascites[J].Liver Int, 2004, 24 (5) :457-464.

[13]RSSLE M, GERBES AL.TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax:a critical update[J].Gut, 2010, 59 (7) :988-1000.

[14]NARAHARA Y, KANAZAWA H, FUKUDA T, et al.Transjugular intrahepatic portosystemic shunt versus paracentesis plus albumin in patients with refractory ascites who have good hepatic and renal function:a prospective randomized trial[J].J Gastroenterol, 2011, 46 (1) :78-85.

[15]SALERNO F, CAMMC, ENEA M, et al.Transjugular intrahepatic portosystemic shunt for refractory ascites:a meta-analysis of individual patient data[J].Gastroenterology, 2007, 133 (3) :825-834.

[16]SPENCER EB, COHEN DT, DARCY MD.Safety and efficacy of transjugular intrahepatic portosystemic shunt creation for the treatment of hepatic hydrothorax[J].J Vasc Interv Radiol, 2002, 13 (4) :385-390.

[17]SIEGERSTETTER V, DEIBERT P, OCHS A, et al.Treatment of refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt:long-term results in 40 patients[J].Eur J Gastroenterol Hepatol, 2001, 13 (5) :529-534.

[18]GINS P, SCHRIER RW.Renal failure in cirrhosis[J].N Engl J Med, 2009, 361 (13) :1279-1290.

[19]GINS A, ESCORSELL A, GINS P, et al.Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites[J].Gastroenterology, 1993, 105 (1) :229-236.

[20]ALESSANDRIA C, OZDOGAN O, GUEVARA M, et al.MELD score and clinical type predict prognosis in hepatorenal syndrome:relevance to liver transplantation[J].Hepatology, 2005, 41 (6) :1282-1289.

[21]BRENSING KA, TEXTOR J, PERZ J, et al.Long term outcome after transjugular intrahepatic portosystemic stent-shunt in nontransplant cirrhotics with hepatorenal syndrome:a phaseⅡstudy[J].Gut, 2000, 47 (2) :288-295.

[22]MENON KV, SHAH V, KAMATH PS.The Budd-Chiari syndrome[J].N Engl J Med, 2004, 350 (6) :578-585.

[23]FISHER NC, MCCAFFERTY I, DOLAPCI M, et al.Managing Budd-Chiari syndrome:a retrospective review of percutaneous hepatic vein angioplasty and surgical shunting[J].Gut, 1999, 44 (4) :568-574.

[24]VALLA D, HADENGUE A, EL YOUNSI M, et al.Hepatic venous outflow block caused by short-length hepatic vein stenoses[J].Hepatology, 1997, 25 (4) :814-819.

[25]SEIJO S, PLESSIER A, HOEKSTRA J, et al.Good long-term outcome of Budd-Chiari syndrome with a step-wise management[J].Hepatology, 2013, 57 (5) :1962-1968.

[26]FITSIORI K, TSITSKARI M, KELEKIS A, et al.Transjugular intrahepatic portosystemic shunt for the treatment of Budd-Chiari syndrome patients:results from a single center[J/OL].Cardiovasc Intervent Radiol, 2013[2013-12-01].link.springer.com/article/10.1007%2Fs00270-013-0697-9.[published online ahead of print July 17, 2013].

[27]FRANCOZ C, VALLA D, DURAND F.Portal vein thrombosis, cirrhosis, and liver transplantation[J].J Hepatol, 2012, 57 (1) :203-212.

[28]TRIPODI A, PRIMIGNANI M, CHANTARANGKUL V, et al.An imbalance of pro-vs anti-coagulation factors in plasma from patients with cirrhosis[J].Gastroenterology, 2009, 137 (6) :2105-2111.

[29]van HA TG, HODGE J, FUNAKI B, et al.Transjugular intrahepatic portosystemic shunt placement in patients with cirrhosis and concomitant portal vein thrombosis[J].Cardiovasc Intervent Radiol, 2006, 29 (5) :785-790.

[30]LI H, HANG GH, YIN ZX, et al.Clinical study on transjugular intrahepatic portosystemic shunt in treatment of portal hypertension of patients with hepatocellular carcinoma[J].Chin J Dig, 2010, 30 (5) :293-295. (in Chinese) 李昊, 韩国宏, 殷占新, 等.经颈静脉肝内门腔静脉分流术治疗肝癌合并门静脉高压的临床研究[J].中华消化杂志, 2010, 30 (5) :293-295.

[31]KRAJINA A, HULEK P, FEJFAR T, et al.Quality improvement guidelines for Transjugular Intrahepatic Portosystemic Shunt (TIPS) [J].Cardiovasc Intervent Radiol, 2012, 35 (6) :1295-1300.

[32]TESDAL IK, FILSER T, WEISS C, et al.Transjugular intrahepatic portosystemic shunts:adjunctive embolotherapy of gastroesophageal collateral vessels in the prevention of variceal rebleeding[J].Radiology, 2005, 236 (1) :360-367.

[33]CHEN S, LI X, WEI B, et al.Recurrent variceal bleeding and shunt patency:prospective randomized controlled trial of transjugular intrahepatic portosystemic shunt alone or combined with coronary vein embolization[J].Radiology, 2013, 268 (3) :900-906.

[34]PETERSEN B, BINKERT C.Intravascular ultrasound-guided direct intrahepatic portacaval shunt:midterm follow-up[J].J Vasc Interv Radiol, 2004, 15 (9) :927-938.

[35]FIDELMAN N, KWAN SW, LABERGE JM, et al.The transjugular intrahepatic portosystemic shunt:an update[J].AJR Am J Roentgenol, 2012, 199 (4) :746-755.

[36]RSSLE M.TIPS:25 years later[J].J Hepatol, 2013, 59 (5) :1081-1093.

[37] RIGGIO O, ANGELONI S, SALVATORI FM, et al.Incidence, natural history, and risk factors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt with polytetra-fluoroethylene-covered stent grafts[J].Am J Gastroenterol, 2008, 103 (11) :2738-2746.

[38] CURA M, CURA A, SURI R, et al.Causes of TIPS dysfunction[J].AJR Am J Roentgenol, 2008, 191 (6) :1751-1757.

[39]DUCOIN H, EL-KHOURY J, ROUSSEAU H, et al.Histopathologic analysis of transjugular intrahepatic portosystemic shunts[J].Hepatology, 1997, 25 (5) :1064-1069.

[40]SANYAL AJ, CONTOS MJ, YAGER D, et al.Development of pseudointima and stenosis after transjugular intrahepatic portasystemic shunts:characterization of cell phenotype and function[J].Hepatology, 1998, 28 (1) :22-32.

[41]XIANG Q, LI X, ZHANG MG, et al.TIPS with covered stents improved shunt insuffidency and portal hypertension:a systematic review[J].Chin J Pract Intern Med, 2008, 28 (3) :190-193. (in Chinese) 向谦, 李肖, 张铭光, 等.采用覆膜支架经颈静脉肝内门体分流对改善术后分流道狭窄及门静脉高压的系统评价[J].中国实用内科杂志, 2008, 28 (3) :190-193.

[42] ROSSI P, SALVATORI FM, FANELLI F, et al.Polytetra-fluoroethylene-covered nitinol stent-graft for transjugular intrahepatic portosystemic shunt creation:3-year experience[J].Radiology, 2004, 231 (3) :820-830.

[43]YANG JH, TANG YM.Transjugular intrahepatic portosystemic shunt:some related medical problems[J].Chin J Hepatol, 2011, 19 (7) :483. (in Chinese) 杨晋辉, 唐映梅.经颈静脉肝内门体分流术相关内科问题[J].中华肝脏病杂志, 2011, 19 (7) :483.

[44]LABERGE JM, FERRELL LD, RING EJ, et al.Histopathologic study of stenotic and occluded transjugular intrahepatic portosystemic shunts[J].J Vasc Interv Radiol, 1993, 4 (6) :779-786.

[45]SAXON RR, MENDEL-HARTVIG J, CORLESS CL, et al.Bile duct injury as a major cause of stenosis and occlusion in transjugular intrahepatic portosystemic shunts:comparative histopathologic analysis in humans and swine[J].J Vasc Interv Radiol, 1996, 7 (4) :487-497.

[46]ZHENG G, ZHANG LJ, ZHONG J, et al.Cerebral blood flow measured by arterial-spin labeling MRI:a useful biomarker for characterization of minimal hepatic encephalopathy in patients with cirrhosis[J].Eur J Radiol, 2013, 82 (11) :1981-1988.

[47]DAM G, KEIDING S, MUNK OL, et al.Hepatic encephalopathy is associated with decreased cerebral oxygen metabolism and blood flow, not increased ammonia uptake[J].Hepatology, 2013, 57 (1) :258-265.

[48]RIGGIO O, NARDELLI S, MOSCUCCI F, et al.Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt[J].Clin Liver Dis, 2012, 16 (1) :133-146.

[49]RIGGIO O, MASINI A, EFRATI C, et al.Pharmacological prophylaxis of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt:a randomized controlled study[J].J Hepatol, 2005, 42 (5) :674-679

[50]KHUNGAR V, POORDAD F.Management of overt hepatic encephalopathy[J].Clin Liver Dis, 2012, 16 (1) :73-89.

施引文献

资源附件(0)

访问统计