肝硬化患者的TIPS和肝脑病变
Pauline Bozon-Rivière1, Marika Rudler2,3, Nicolas Weiss4,5
1Liver Intensive Care Unit, Hepatogastroenterology Department, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, Paris, 75013, France.
Metabolic brain disease
|February 4, 2025
概括
肝脏脑病变 (HE) 是跨内肝脏移植系统 (TIPS) 的常见并发症. 患者选择和管理策略至关重要,特别是对于可选的TIPS,以减轻HE风险.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 干预性放射学 干预性放射学
- 胃肠病学 胃肠病学
背景情况:
- 肝发性脑病变 (HE) 是跨内肝脏移植系统阻塞 (TIPS) 的重要并发症,影响35-50%的患者.
- HE的发生率和管理因TIPS的适用性而异,包括救援,预防性 (pTIPS) 和选择性程序.
研究的目的:
- 分析肝脏脑病变的流行病学和管理在经过过关节内肝脏移植系统休顿的患者.
- 在TIPS的背景下,为预防和管理HE提供有关患者选择和治疗策略的指导.
主要方法:
- 关于肝脏脑病和TIPS程序的当前文献和临床建议的审查.
- 基于不同的TIPS指示 (救援,pTIPS,可选) 的HE流行和风险因素分析.
- 对HE的治疗策略的评估,包括药理 (乳糖,利法西明) 和营养管理,以及肝移植.
主要成果:
- 他不应该违反救援或先发制人的提示,特别是当出血是一个沉因素.
- 选择性TIPS需要在手术前仔细选择患者,识别和纠正HE风险因素.
- 为减少HE风险,建议在接受选择性TIPS的选定患者中使用预防性rifaximin.
结论:
- 选择性TIPS的患者选择至关重要,以尽量减少肝脏脑病变的风险.
- 在TIPS后的HE管理包括识别触发因素,适当的医疗治疗和营养支持.
- 高风险患者或TIPS后耐火性HE患者应考虑进行肝移植.
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