Department of Medical Clinic B, University Hospital Muenster, Muenster, Germany.
Medical Department I, Frankfurt University Hospital, Frankfurt am Main, Germany.
Semin Liver Dis. 2023 May;43(2):189-205. doi: 10.1055/a-2107-0576. Epub 2023 Jun 7.
Variceal bleeding is a consequence of severe portal hypertension in patients with liver cirrhosis. Although the rate of bleeding has decreased over time, variceal bleeding in the presence of acute-on-chronic liver failure (ACLF) carries a high risk of treatment failure and short-term mortality. Treatment and/or removal of precipitating events (mainly bacterial infection and alcoholic hepatitis) and decrease of portal pressure may improve outcome of patients with acute decompensation or ACLF. Transjugular intrahepatic portosystemic shunts (TIPSs), especially in the preemptive situation, have been found to efficiently control bleeding, prevent rebleeding, and reduce short-term mortality. Therefore, TIPS placement should be considered in the management of ACLF patients with variceal bleeding.
静脉曲张出血是肝硬化患者严重门静脉高压的后果。尽管随着时间的推移，出血率有所下降，但在慢加急性肝衰竭（ACLF）存在的情况下，静脉曲张出血具有治疗失败和短期死亡率高的风险。治疗和/或消除诱发事件（主要是细菌感染和酒精性肝炎）和降低门静脉压力可能会改善急性失代偿或 ACLF 患者的预后。经颈静脉肝内门体分流术（TIPS），特别是在预防性情况下，已被发现可有效控制出血、预防再出血和降低短期死亡率。因此，在静脉曲张出血的 ACLF 患者的管理中应考虑 TIPS 放置。
