经皮经肝肝内门体分流术后肝性脑病发病机制及其预防

Pathogenesis of hepatic encephalopathy and its prevention after transjugular intrahepatic portosystemic shunt

随着经皮经肝肝内门体分流技术(transjugular intrahepatic portosystemic shunt,TIPS)的不断应用,其在食管胃底静脉曲张破裂出血和顽固性腹水的治疗方面,取得了突破性进展.然而,TIPS术后支架的狭窄闭塞和反复高发的肝性脑病(hepatic encephalopathy,HE)或称为分流性脑病(portal-systemic encephalopathy,PSE)成为困扰TIPS技术发展的两大难题,前者在近期带膜(血管)支架的大量应用后,得到极大的改善;后者始终未得到根本的解决,我们参阅了国内外的最新资料,在此进一步阐述TIPS术后另一难题-肝性脑病的发生情况.

With the increasing use of transjugular intrahepatic portosystemic shunt （TIPS）, we have obtained a breakout progress in the therapy of acute esophageal and gastric-fundus variceal bleeding and refractory ascites, whereas the patency of stent and hepatic encephalopathy （or namely portal-systemic encephalopathy, PSE） after TIPS become two great problems for TIPS. The patency of stent has been improved greatly after the use of covered stent such as Viator stents or covered vascular stents. But the problem of hepatic encephalopathy has not been well solved. In this review, we try to explore the pathogenesis of hepatic encephalopathy and its prevention after TIPS.