经颈静脉肝内门体分流术后肝性脑病诊治进展

发布时间：2018-05-11 16:37

本文选题：经颈静脉肝内门体静脉分流术 + 肝硬化　；参考：《重庆医科大学》2017年硕士论文

【摘要】：经颈静脉肝内门体静脉分流术(transjugular intrahepatic portosystemic shunt,TIPS)是一种微创介入技术,随着覆膜支架的应用及支架通畅率的逐步改善,目前已成为治疗肝硬化门静脉高压并发症的一项重要方法,其临床上适应症广,尤其是应用于经传统方法治疗效果欠佳的肝硬化食管胃底静脉曲张破裂出血(esophageal-gastric varices bleeding,EVB)、难治性腹水,同时也广泛用于治疗肝硬化伴Budd-Chiari综合征、门脉高压性胃病、肝性胸水以及肝移植术前的过度治疗等。TIPS能降低EVB、顽固性腹水的危险主要是通过有效降低门脉压力来实现的,但分流的同时也减少了肝脏的血流灌注,这样的结局是可能会加重肝功能的损害和导致门体分流性脑病。TIPS术后难治性肝性脑病患者生活质量低、预后差、死亡率高,且目前没有根治方法,故仍以预防为主,为预防TIPS术后肝性脑病的发生,医务人员需要全面评估肝性脑病发生的相关影响因素。TIPS术后肝性脑病的诊治仍是目前面临的一大挑战,本文主要从其发病机制、相关影响因素及诊治方面作全面综述,以提高人们对该病的认识。
[Abstract]:Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive interventional technique. With the application of covered stent and the improvement of patency rate of stent, it has become an important method for the treatment of complications of cirrhotic portal hypertension. It is widely used in the treatment of cirrhosis with Budd-Chiari syndrome, portal hypertensive gastropathy, esophageal varices bleeding, refractory ascites, especially in patients with cirrhosis and gastroesophageal variceal bleeding. It is also widely used in the treatment of cirrhosis with Budd-Chiari syndrome and portal hypertensive gastropathy. Hepatic pleural effusion and over-treatment before liver transplantation can reduce EVB.The risk of intractable ascites is mainly achieved by reducing portal pressure, but shunt also reduces hepatic perfusion. This outcome may aggravate the damage of liver function and lead to low quality of life, poor prognosis and high mortality in patients with refractory hepatic encephalopathy after portosystemic shunt encephalopathy. In order to prevent the occurrence of hepatic encephalopathy after TIPS, medical staff need to evaluate the influencing factors of hepatic encephalopathy. The diagnosis and treatment of hepatic encephalopathy after tips is still a major challenge. The related influencing factors, diagnosis and treatment were summarized to improve the understanding of the disease.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575

【相似文献】