Garbuzenko Dmitry Victorovich
Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk 454092, Russia.
World J Hepatol. 2024 Jun 27;16(6):891-899. doi: 10.4254/wjh.v16.i6.891.
This editorial describes the milestones to optimize of transjugular intrahepatic portosystemic shunt (TIPS) technique, which have made it one of the main methods for the treatment of portal hypertension complications worldwide. Innovative ideas, subsequent experimental studies and preliminary experience of use in cirrhotic patients contributed to the introduction of TIPS into clinical practice. At the moment, the main achievement in optimize of TIPS technique is progress in the qualitative characteristics of stents. The transition from bare metal stents to extended polytetrafluoroethylene-covered stent grafts made it possible to significantly prevent shunt dysfunction. However, the question of its preferred diameter, which contributes to an optimal reduction of portal pressure without the risk of developing post-TIPS hepatic encephalopathy, remains relevant. Currently, hepatic encephalopathy is one of the most common complications of TIPS, significantly affecting its effectiveness and prognosis. Careful selection of patients based on cognitive indicators, nutritional status, assessment of liver function, , will reduce the incidence of post-TIPS hepatic encephalopathy and improve treatment results. Optimize of TIPS technique has significantly expanded the indications for its use and made it one of the main methods for the treatment of portal hypertension complications. At the same time, there are a number of limitations and unresolved issues that require further randomized controlled trials involving a large cohort of patients.
这篇社论描述了经颈静脉肝内门体分流术（TIPS）技术优化的里程碑，这使其成为全球治疗门静脉高压并发症的主要方法之一。创新理念、后续的实验研究以及在肝硬化患者中的初步使用经验促使TIPS引入临床实践。目前，TIPS技术优化的主要成就是支架质量特性方面的进展。从裸金属支架过渡到覆膜聚四氟乙烯支架移植物能够显著预防分流功能障碍。然而，有助于在不发生TIPS术后肝性脑病风险的情况下最佳降低门静脉压力的首选直径问题仍然存在。目前，肝性脑病是TIPS最常见的并发症之一，严重影响其有效性和预后。基于认知指标、营养状况、肝功能评估等仔细选择患者，将降低TIPS术后肝性脑病的发生率并改善治疗效果。TIPS技术的优化显著扩大了其使用适应症，并使其成为治疗门静脉高压并发症的主要方法之一。与此同时，存在一些局限性和未解决的问题，需要进一步开展涉及大量患者队列的随机对照试验。
