Manning Charelle, Elzubeir Amera, Alam Syed
Department of Gastroenterology and Hepatology, Norfolk and Norwich University Hospital, Norwich, UK.
Norfolk and Norwich University Hospital, Norwich, NR4 7UB, UK.
Ther Adv Chronic Dis. 2021 Mar 5;12:2040622321995771. doi: 10.1177/2040622321995771. eCollection 2021.
The development of portal hypertension has serious implications in the natural history of liver cirrhosis, leading to complications such as ascites, hepatic encephalopathy and variceal bleeding. The management of acute variceal bleeding has improved in the last two decades, but despite the advances in endoscopic methods the overall prognosis remains poor, particularly within a subgroup of patients with more advanced disease. The role of Transjugular Intrahepatic Portosystemic Shunt (TIPSS) is a well-established method of achieving haemostasis by immediate portal decompression; however, its use in an emergency setting as a rescue strategy is still associated with high mortality. It has been shown that 'early' use of TIPSS as a pre-emptive strategy in a patient with acute variceal bleed in addition to the standard of care confers superior survival outcomes in a subgroup of patients at high risk of treatment failure and death. The purpose of this review is to appraise the literature around the indications, patient selection, utility, complications and economic considerations of pre-emptive TIPSS.
门静脉高压的发展在肝硬化自然病程中具有严重影响，可导致诸如腹水、肝性脑病和静脉曲张出血等并发症。在过去二十年中，急性静脉曲张出血的治疗已有改善，但尽管内镜方法取得了进展，总体预后仍然较差，尤其是在疾病更晚期的患者亚组中。经颈静脉肝内门体分流术（TIPSS）的作用是通过立即进行门静脉减压来实现止血的一种成熟方法；然而，将其作为紧急情况下的抢救策略使用仍与高死亡率相关。研究表明，在急性静脉曲张出血患者中，除了标准治疗外，“早期”使用TIPSS作为一种抢先策略，在治疗失败和死亡风险高的患者亚组中可带来更好的生存结果。本综述的目的是评估有关抢先TIPSS的适应证、患者选择、效用、并发症和经济考量的文献。
