[1].门静脉高压介入性精准分流[J].介入放射学杂志,2024,33(10):1045-1048.
　MA Jingqin,LUO Jianjun,YAN Zhiping..Interventional precision shunting for portal hypertension[J].journal interventional radiology,2024,33(10):1045-1048.
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门静脉高压介入性精准分流()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
33
期数:
2024年10
页码:
1045-1048
栏目:
专论
出版日期:
2024-10-21

文章信息/Info

Title:
Interventional precision shunting for portal hypertension
Author(s):
MA Jingqin; LUO Jianjun; YAN Zhiping.
Department of Interventional Radiology，Affiliated Zhongshan Hospital of Fudan University；National Clinical Research Center for Interventional Medicine；Shanghai Institution of Medical Imaging，Shanghai 200032，China
关键词:
【关键词】介入性分流; 经颈静脉肝内门体分流术; 精准分流; 门静脉高压; 门静脉压力梯度
文献标志码:
A
摘要:
马婧嶔，罗剑钧，颜志平【摘要】门静脉高压是门静脉压力梯度（portal pressure gradient，PPG）病理性升高，常导致严重并发症。介入性分流如经颈静脉肝内门体分流术已逐渐成为重要治疗手段，但患者术后血流动力学变化不确定，需要精准分流以实现个体化治疗。精准分流旨在平衡分流量与肝组织血液灌注，在缓解症状的同时最小化并发症。介入性分流术后血流动力学目标确定受多种因素影响，合理的术后血流动力学目标（合理PPG）应综合考虑术式差异与个体差异。精准分流初步临床实践强调对术前门静脉压力的准确测量以及对术后血流动力学状态的有效监测。未来研究应进一步完善介入性分流技术，以实现更为个体化和精准的治疗。

参考文献/References:

［1］Garcia-Tsao G，Abraldes JG，Berzigotti A，et al.Portal hypertensive bleeding in cirrhosis：risk stratification，diagnosis，and management：2016 practice guidance by the American Association for the Study of Liver Diseases［J］.Hepatology，2017，65：310-335.
［2］Palmaz JC，Sibbitt RR，Reuter SR，et al.Expandable intrahepatic portacaval shunt stents：early experience in the dog［J］.AJR Am J Roentgenol，1985，145：821-825.
［3］Colapinto RF，Stronell RD，Gildiner M，et al.Formation of intrahepatic portosystemic shunts using a balloon dilatation catheter：preliminary clinical experience［J］.AJR Am J Roentgenol，1983，140：709-714.
［4］Burgener FA，Gutierrez OH.Nonsurgical production of intrahepatic portosystemic venous shunts in portal hypertension with the double lumen balloon catheter （author′s transl）［J］.Rofo，1979，130：686-688.
［5］Rsch J，Hanafee W，Snow H，et al.Transjugular intrahepatic portacaval shunt.An experimental work［J］.Am J Surg，1971，121：588-592.
［6］颜志平，罗剑钧.重视经门脉系统的介入诊治［J］.介入放射学杂志，2009，18：561-562.
［7］马婧嶔，罗剑钧.“TIPS先行”的临床实践与探索［J］.肝脏，2019，24：1097-1099.
［8］Ma L，Ma J，Zhang W，et al.Acute hepatic ischemia after transjugular intrahepatic portosystemic shunt creation despite preserved arterial perfusion［J］.J Vasc Interv Radiol，2021，32：1510-1512.
［9］Kloster ML，Ren A，Shah KY，et al.High incidence of hepatic encephalopathy after viatorr controlled expansion transjugular intrahepatic portosystemic shunt creation［J］.Dig Dis Sci，2021，66：4058-4062.
［10］Perry BC，Kwan SW.Portosystemic shunts：stable utilization and improved outcomes，two decades after the transjugular intrahepatic portosystemic shunt［J］.J Am Coll Radiol，2015，12：1427-1433.
［11］Pericleous M，Sarnowski A，Moore A，et al.The clinical management of abdominal ascites，spontaneous bacterial peritonitis and hepatorenal syndrome：a review of current guidelines and recommendations［J］.Eur J Gastroenterol Hepatol，2016，28：e10-e18.
［12］European Association for the Study of the Liver.EASL clinical practice guidelines for the management of patients with decompensated cirrhosis［J］.J Hepatol，2018，69：406-460.
［13］Chinese College of Interventionalists.CCI clinical practice guidelines：management of TIPS for portal hypertension （2019 edition）［J］.Zhonghua Gan Zang Bing Za Zhi，2019，27：582-593.
［14］Tripathi D，Stanley AJ，Hayes PC，et al.Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension［J］.Gut，2020，69：1173-1192.
［15］曹家伟，丁鹏绪，段峰，等.中国门静脉高压经颈静脉肝内门体分流术临床实践指南（2019年版）［J］.临床肝胆病杂志，2019，35：2694-2699.
［16］任洪成，王斌，邵长刚，等.不同支架肝静脉端形态对经颈静脉肝内门体分流术后疗效的影响［J］.介入放射学杂志，2023，32：1001-1005.
［17］Wang XZ，Liu GF，Wu JC，et al.Small-diameter transjugular intrahepatic portosystemic shunt versus endoscopic variceal ligation plus propranolol for variceal rebleeding in advanced cirrhosis［J］.Radiology，2023，308：e223201.
［18］Yan H，Xiang Z，Zhao C，et al.6-mm shunt transjugular intrahepatic portosystemic shunt in patients with severe liver atrophy and variceal bleeding［J］.Eur Radiol，2024，34:4697-4707.
［19］Wang Q，Lv Y，Bai M，et al.Eight millimetre covered TIPS does not compromise shunt function but reduces hepatic encephalopathy in preventing variceal rebleeding［J］.J Hepatol，2017，67：508-516.
［20］Trebicka J，Bastgen D，Byrtus J，et al.Smaller-diameter covered transjugular intrahepatic portosystemic shunt stents are associated with increased survival［J］.Clin Gastroenterol Hepatol，2019，17：2793.e1-2799.e1.
［21］Borghol S，Perarnau JM，Pucheux J，et al.Short-and long-term evolution of the endoluminal diameter of underdilated stents in transjugular intrahepatic portosystemic shunt［J］.Diagn Interv Imaging，2016，97：1103-1107.
［22］Liu J，Ma J，Zhou C，et al.Potential benefits of underdilation of 8-mm covered stent in transjugular intrahepatic portosystemic shunt creation［J］.Clin Transl Gastroenterol，2021，12：e00376.
［23］Miraglia R，Maruzzelli L，Di Piazza A，et al.Transjugular intrahepatic portosystemic shunt using the new gore viatorr controlled expansion endoprosthesis：prospective，single-center，preliminary experience［J］.Cardiovasc Intervent Radiol，2019，42：78-86.
［24］Praktiknjo M，Abu-Omar J，Chang J，et al.Controlled underdilation using novel VIATORR controlled expansion stents improves survival after transjugular intrahepatic portosystemic shunt implantation［J］.JHEP Rep，2021，3：100264.
［25］de Franchis R，Bosch J，Garcia-Tsao G，et al.Baveno Ⅶ-renewing consensus in portal hypertension［J］.J Hepatol，2022，76：959-974.
［26］Ma L，Ma J，Zhang W，et al.Predictive power of portal pressure gradient remeasured shortly after transjugular intrahepatic portosystemic shunt［J］.Hepatol Int，2023，17：417-426.
［27］Biecker E，Roth F，Heller J，et al.Prognostic role of the initial portal pressure gradient reduction after TIPS in patients with cirrhosis［J］.Eur J Gastroenterol Hepatol，2007，19：846-852.
［28］Bosch J.Small diameter shunts should lead to safe expansion of the use of TIPS［J］.J Hepatol，2021，74：230-234.
［29］Ma L，Liu Y，Yan Z，et al.Comparing the predictive ability of portoatrial and portocaval gradient after transjugular intrahepatic portosystemic shunt creation for variceal rebleeding［J］.J Gastroenterol，2023，58：494-502.
［30］曹俊杰，姚志超，刘占鳌，等.个体化经颈静脉肝内门体分流术血流动力学模拟研究［J］.介入放射学杂志，2023，32：17-21.
［31］Xia Y，Tie J，Wang G，et al.Individualized portal pressure gradient threshold based on liver function categories in preventing rebleeding after TIPS［J］.Hepatol Int，2023，17：967-978.
［32］Zhao D，Zhang G，Wang M，et al.Portal pressure gradient and serum albumin：a simple combined parameter associated with the appearance of ascites in decompensated cirrhosis treated with transjugular intrahepatic portosystemic shunt［J］.Clin Mol Hepatol，2019，25：210-217.
［33］Ma J，Gong X，Luo J，et al.Impact of intrahepatic venovenous shunt on hepatic venous pressure gradient measurement［J］.J Vasc Interv Radiol，2020，31：2081-2088.

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备注/Memo

备注/Memo:
（收稿日期：2024-02-18）
（本文编辑：谷珂）
更新日期/Last Update: 2024-10-17