经颈内静脉肝内门体分流术临床应用新进展

Recent advances in the clinical application of transjugular intrahepatic portosystemic shunt for the treatment of portal hypertension

自从1988年经颈内静脉肝内门体分流术(TIPS)首次应用于临床以来,TIPS的相关知识被不断地更新与完善。大量随机对照试验显示TIPS在预防静脉曲张再出血及控制顽固性腹水方面明显优于内镜治疗及穿刺放腹水。在发达国家TIPS已经被广泛地应用于预防食管静脉曲张再出血及治疗顽固性腹水。然而,术后较高的分流道功能失常及肝性脑病发生率仍严重地限制了TIPS的应用。本文着重回顾TIPS技术的发展,TIPS适应证、禁忌证及术后并发症的防治以助于指导临床实践。

Since the successful creation of a transjugular intrahepatic portosystemic shunt（TIPS） in a cirrhotic patient with uncontrolled variceal bleeding was firstly reported in 1988,the relevant information about TIPS has been continually updated and perfected.Compared with surgical portocaval shunt,its major advantages include minimal invasiveness,no need of general anesthesia and lower technical difficulty.In developed countries TIPS procedure has been wildly employed for the prevention of esophageal variceal rebleeding and the treatment of refractory ascites need to be considered.Recently,many randomized controlled trials have showed that TIPS is superior to endoscopic therapy and large volume paracentesis in preventing variceal rebleeding and in controlling ascites,respectively.But the effort to popularize its clinical application is,to a large extent,hindered by the higher occurrence of the postoperative shunt dysfunction and the hepatic encephalopathy.This paper aims to make a comprehensive review of TIPS,with the focus being on the development of the technique,its indications and contraindications,and the complications in order to guide the clinical practice.