《2009AASLD实践指南：应用TIPS治疗门脉高压症》内容预览

TIPS has been in use for more than 20 years to treat thecomplications of portal hypertension and TIPS have beencreated in thousands of patients with liver disease world-wide.Despite the extensive use of TIPS to treat thecomplications of portal hypertension there initially was alack of consensus on which patients should receive a TIPSas compared to other forms of therapy. In 1995 a confer-ence sponsored by the National Institutes of Health con-cluded that TIPS was effective in the acute control andprevention of recurrent bleeding from varices but it wasunclear when TIPS should be used as compared to med-ical and surgical therapy for these complications of portalhypertension. In addition, the efficacy of TIPS to controlrefractory ascites or treat the Budd-Chiari syndrome wasunclear but promising.Since then, more than one thou-sand patients have been enrolled in multiple controlledtrials comparing TIPS to endoscopic and pharmacologictherapy in the prevention of rebleeding from varices andto large volume paracentesis in the treatment of refractorycirrhotic ascites. Further, about a 1,000 papers have beenpublished on TIPS in the English literature alone. Thisbody of work allows for more definitive recommendationsabout in whom and when to use TIPS in the treatment ofthe complications of portal hypertension.

The guidelines are divided into two large categories.The first category is a review of the technical aspects of theprocedure, its complications and the data on which pa-tients are most at risk for an adverse outcome following aTIPS. The second category is a review of the indicationsfor TIPS. The use of TIPS for primary prevention ofvariceal bleeding and in the control of acute bleeding arediscussed first. Next the two indications for TIPS thathave been subjected to controlled trials (prevention ofrecurrent bleeding from varices and refractory ascites) willbe discussed and guidelines developed. Lastly, all of theother indications for TIPS that have been described in theliterature but have not been subjected to controlled trialswill be discussed and guidelines created.

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