经颈静脉肝内门体分流术治疗门静脉高压性顽固性腹水的现状及进展

Current status and advances in transjugular intrahepatic portosystemic shunt in treatment of refractory ascites due to portal hypertension

顽固性腹水是肝硬化失代偿期门静脉高压的常见并发症之一,预后极差,病死率较高。经颈静脉肝内门体分流术(TIPS)被多项国际及国内指南推荐用于大量腹腔穿刺抽放腹水(LVP)联合输蛋白治疗失败后的治疗方法之一。TIPS可有效控制腹水再发,但有增加肝性脑病的风险,且其是否能延长生存时间仍存在争议。随着对TIPS认识的不断深入、手术技术的成熟、支架材料的更新,迫切需要重新评价TIPS在治疗门静脉高压性顽固性腹水领域中的地位。本文对TIPS治疗门静脉高压性顽固性腹水的现状及进展作一综述。

Refractory ascites is one of the common complications of portal hypertension in decompensated liver cirrhosis and is characterized by extremely poor prognosis and high mortality rate.Transjugular intrahepatic portosystemic shunt(TIPS)is recommended by several international and national guidelines as one of the treatment methods after failure of large volume paracentesis combined protein infusion therapy.TIPS can effectively control the recurrence of ascites,but it can increase the risk of hepatic encephalopathy,and there are still controversies over whether it can prolong survival time.With a deeper understanding of TIPS,the maturity of surgical techniques,and the update of stent materials,it is urgent to reevaluate the position of TIPS in the treatment of refractory ascites due to portal hypertension.This article reviews the current status and advances in TIPS for the treatment of refractory ascites due to portal hypertension.