Lapenna Lucia, Di Cola Simone, Gazda Jakub, De Felice Ilaria, Gioia Stefania, Merli Manuela
Department of Translational and Precision Medicine, Sapienza University of Rome, Italy.
2nd Department of Internal Medicine, PJ Safarik University and L. Pasteur University Hospital in Kosice, Slovakia.
J Clin Exp Hepatol. 2023 Sep-Oct;13(5):794-803. doi: 10.1016/j.jceh.2023.01.017. Epub 2023 Feb 10.
Since 1988, transjugular intrahepatic portosystemic shunt (TIPS) has been an effective therapy for portal hypertension in many settings. Thanks to continuous technical improvements and a wiser selection of patients, excellent results have been achieved with this therapeutic strategy. The historical indications for TIPS placement, in the context of liver cirrhosis, such as refractory ascites and variceal bleeding are now well established and known. However, in recent years, new indications are emerging. These have been investigated and approved in some studies but are not yet included in guidelines and clinical practice. This review aims to highlight what is new for the role of TIPS in portal vein thrombosis (especially in patients awaiting liver transplantation), in recurrent ascites and not only refractory ascites, as a neoadjuvant therapy before abdominal surgery and, finally, in the setting of noncirrhotic portal hypertension. All these new aspects are addressed in this review with a critical approach based on the literature revision and clinical practice. Future research is needed to explore and validate the new role of TIPS in these scenarios.
自1988年以来，经颈静脉肝内门体分流术（TIPS）在许多情况下一直是治疗门静脉高压的有效方法。由于技术的不断改进和对患者更明智的选择，这种治疗策略取得了优异的效果。在肝硬化背景下，TIPS置入的传统适应证，如难治性腹水和静脉曲张出血，现已得到充分确立和广泛认知。然而，近年来，新的适应证不断涌现。这些适应证在一些研究中已得到调查和认可，但尚未纳入指南和临床实践。本综述旨在强调TIPS在门静脉血栓形成（特别是在等待肝移植的患者中）、复发性腹水（不仅是难治性腹水）、腹部手术前作为新辅助治疗以及非肝硬化门静脉高压中的新作用。本综述基于文献回顾和临床实践，以批判性的方法探讨了所有这些新方面。未来需要开展研究来探索和验证TIPS在这些情况下的新作用。
