Schindler Philipp, Heinzow Hauke, Trebicka Jonel, Wildgruber Moritz
Institute of Clinical Radiology, University Hospital Muenster, D-48149 Muenster, Germany.
Department of Gastroenterology and Hepatology, University Hospital Muenster, D-48149 Muenster, Germany.
J Clin Med. 2020 Nov 23;9(11):3784. doi: 10.3390/jcm9113784.
Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment tool in decompensated liver cirrhosis that has been shown to prolong transplant-free survival. Hepatic encephalopathy (HE) is a frequent complication of decompensated cirrhosis, eventually induced and/or aggravated by TIPS, that remains a clinical challenge especially in these patients. Therefore, patient selection for TIPS requires careful assessment of risk factors for HE. TIPS procedural parameters regarding stent size and invasive portosystemic pressure gradient measurements thereby have an important role. Endovascular shunt modification, in combination with a conservative medical approach, often results in a significant reduction of symptoms. This review summarizes HE molecular mechanisms and pathophysiology as well as diagnostic and therapeutic approaches targeting shunt-induced HE.
经颈静脉肝内门体分流术（TIPS）是失代偿期肝硬化的一种成熟治疗手段，已被证明可延长无移植生存期。肝性脑病（HE）是失代偿期肝硬化的常见并发症，最终可由TIPS诱发和/或加重，在这些患者中仍然是一项临床挑战。因此，TIPS的患者选择需要仔细评估HE的危险因素。TIPS的手术参数，包括支架尺寸和侵入性门体压力梯度测量，因此具有重要作用。血管内分流术改良联合保守药物治疗，通常可显著减轻症状。本综述总结了HE的分子机制和病理生理学，以及针对分流诱导型HE的诊断和治疗方法。
