Transjugular intrahepatic portosystemic shunt in the management of complications of portal hypertension

被引：24

作者：

Boyer T.D. ^{[1
]}

机构：

[1] Liver Research Institute, AHSC 245136, Tucson, AZ 85724

来源：

Current Gastroenterology Reports | 2008年 / 10卷 / 1期

关键词：

Gastric Varix; Hepatorenal Syndrome; Covered Stents; Refractory Ascites; Portal Hypertensive Gastropathy;

D O I：

10.1007/s11894-008-0006-y

中图分类号：

学科分类号：

摘要：

Transjugular intrahepatic portosystemic shunt (TIPS) is a commonly used approach for managing many complications of portal hypertension. It is an attractive option due to its relative ease of creation (> 90% success rate) and the availability at most hospitals of an interventional radiologist capable of performing the procedure. TIPS is the preferred approach to control acutely bleeding esophageal or gastric varices that cannot be controlled with medical management. It is also now preferred to surgical shunts for preventing rebleeding in patients who rebleed despite adequate medical management. TIPS is more effective than large-volume paracentesis in controlling refractory cirrhotic ascites, with possibly a slight survival benefit but also increased encephalopathy. TIPS should be used to control refractory ascites in patients who cannot be managed with large-volume paracentesis. The role of TIPS in the treatment of hepatorenal syndrome is unclear; currently only patients with type 2 hepatorenal syndrome should be considered candidates for TIPS. © Springer Science+Business Media, LLC 2008.

引用

页码：30 / 35

页数：5

共 41 条

[1]

Groszmann R., Garcia-Tsao G., Bosch J., Et al., Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis, N Engl J Med, 353, pp. 2254-2261, (2005)

[2]

Stokkeland K., Brandt L., Ekbom A., Hultcrantz R., Improved prognosis for patients hospitalized with esophageal varices in Sweden 1969-2002, Hepatology, 43, pp. 500-505, (2006)

[3]

Boyer T.D., Haskel Z., The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension, Hepatology, 41, pp. 386-400, (2005)

[4]

Chalasani N., Clark W.S., Martin L.G., Et al., Determinants of mortality in patients with advanced cirrhosis after transjugular intrahepatic portosystemic shunting, Gastroenterology, 118, pp. 138-144, (2000)

[5]

Malinchoc M., Kamath P.S., Gordon F.D., Et al., A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts, Hepatology, 31, pp. 864-871, (2000)

[6]

Schepke M., Roth F., Fimmers R., Et al., Comparison of MELD, Child-Pugh, and Emory model for the prediction of survival in patients undergoing transjugular intrahepatic portosystemic shunting, Am J Gastroenterol, 98, pp. 1167-1174, (2003)

[7]

Bureau C., Pagan J.C., Layrargues G.P., Et al., Patency of stents covered with polytetrafluoroethylene in patients treated by transjugular intrahepatic portosystemic shunts: Long-term results of a randomized multicenter study, Liver Int, 27, pp. 742-747, (2007)

[8]

Riggio O., Masini A., Efrati C., Et al., Pharmacological prophylaxis of hepatic encephalopathy after transjugular portosystemic shunt: A randomized controlled study, J Hepatol, 42, pp. 674-679, (2005)

[9]

Monescillo A., Martinez-Lagares F., Ruiz del Arbol L., Et al., Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding, Hepatology, 40, pp. 793-801, (2004)

[10]

Vangeli M., Patch D., Burroughs A.K., Salvage tips for uncontrolled variceal bleeding, J Hepatol, 37, pp. 703-704, (2003)

← 1 2 3 4 5 →