经颈静脉肝内门体分流术在急性食管胃静脉曲张出血患者中的治疗时机选择

Selection of therapeutic timing of transjugular intrahepatic portosystemic shunt in patients with acute esophagogastric variceal bleeding

急性食管胃静脉曲张出血(AVB)是肝硬化患者最常见的并发症之一,严重威胁患者的生命安全。经颈静脉肝内门体分流术(TIPS)已经成为治疗AVB的一种重要手段。然而,TIPS的治疗时机选择一直是临床医生面临的难题。优先TIPS治疗可以提高高危患者的生存率,降低再出血率,但对于其他患者的效果尚不明确。目前择期TIPS治疗仍是预防静脉曲张再出血的二线治疗方案。该文从优先TIPS、择期TIPS及挽救性TIPS的角度展开论述,以期为临床医生的决策提供参考依据,以便更好地掌握TIPS的治疗时机选择和注意事项,提高治疗效果和患者的生存率。

Acute variceal bleeding(AVB)is one of the most common complications in the patients with liver cirrhosis,seriously threatening the life safety of the patients.The application of transjugular intrahepatic portosystemic shunt(TIPS)in the treatment of AVB patients has become an important therapeutic approach.However,the selection of TIPS treatment timing has always been a challenging issue for clinical physicians.Priority TIPS treatment can improve the survival rate of high-risk patients and reduce the rebleeding rate,but its effectiveness for other patients remains unclear.Currently,elective TIPS treatment is still a second-line treatment regimen for preventing variceal rebleeding.This paper discussed from the angle of the priority TIPS,alternative TIPS and salvage TIPS in order to provide reference for the clinicians’decision-making and help to better grasp the timing selection and matters needing attention of TIPS treatment,thus enhancing the treatment efficacy and patients’survival rate.