Service d'hépato-gastroentérologie, CHU Côte-de-Nacre, Caen, France.
Service de radiologie, hôpital Jean-Verdier, hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France.
Clin Res Hepatol Gastroenterol. 2020 Jun;44(3):249-263. doi: 10.1016/j.clinre.2019.09.003. Epub 2019 Oct 26.
Portal hypertension is primarily due to liver cirrhosis, and is responsible for complications that include variceal bleeding, ascites and hepatorenal syndrome. The transjugular intrahepatic portosystemic shunt (TIPS) is a low-resistance channel between the portal vein and the hepatic vein, created by interventional radiology, that aims to reduce portal pressure. TIPS is a potential treatment for severe portal-hypertension-related complications, including esophageal and gastric variceal bleeding. TIPS is currently indicated as salvage therapy in this setting when patients fail to respond to standard endoscopic and medical treatment. More recently, early TIPS has been shown to be effective in decreasing risk of rebleeding after variceal hemorrhage and mortality in Child-Pugh B patients with active hemorrhage at endoscopy, and in Child-Pugh C patients. TIPS is also an efficient treatment for refractory ascites and hepatic hydrothorax. In contrast, the role of TIPS in the hepatorenal syndrome has not been precisely defined. The aim of this review was to specifically describe the current role of TIPS in management of portal hypertension in patients with cirrhosis.
门静脉高压主要由肝硬化引起，可导致静脉曲张出血、腹水和肝肾综合征等并发症。经颈静脉肝内门体分流术（TIPS）是介入放射学创建的门静脉和肝静脉之间的低阻力通道，旨在降低门静脉压力。TIPS 是治疗严重门静脉高压相关并发症的一种方法，包括食管和胃静脉曲张出血。目前，当患者对标准内镜和药物治疗无反应时，TIPS 被认为是这种情况下的挽救性治疗。最近的研究表明，TIPS 可有效降低内镜下活动性出血的 Child-Pugh B 级患者再出血风险和死亡率，并可降低 Child-Pugh C 级患者的死亡率。TIPS 也是治疗难治性腹水和肝性胸水的有效方法。相比之下，TIPS 在肝肾综合征中的作用尚未明确。本综述的目的是专门描述 TIPS 在肝硬化患者门静脉高压管理中的当前作用。
