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TIPS适应症:肝性胸水

时间:2021-08-16 21:51来源:www.ynjr.net 作者:杨宁介入医学网
肝性胸水(Hepatic hydrothorax,HH) HH is the accumulation of a significant amount of transudative fluid, usually over 500 mL, in the pleural cavity of patients with decompensated liver cirrhosis without coexisting primary cardiopulmonary

肝性胸水(Hepatic hydrothorax,HH)



HH is the accumulation of a significant amount of transudative fluid, usually over 500 mL, in the pleural cavity of patients with decompensated liver cirrhosis without coexisting primary cardiopulmonary or pleural diseases[105].
HH是在失代偿性肝硬化患者的胸膜腔积液超过500mL同时不伴有原发性心肺或胸腔疾病[105]。
 
It is a relatively uncommon complication of end-stage liver disease, seen in approximately 5%-10% of patients and constitutes 2%-3% of all cases of pleural effusions[105,106].
它是一种相对罕见的终末期肝病并发症,约占5%-10%的患者,是所有胸腔积液[105,106]病例的2%-3%。
 
 It has a dismal prognosis with a median survival of 8-12 mo[107].
其预后较差,中位生存期为8-12个月的[107]。
 
 Approximately 20%-25% of patients with HH have persistent symptomatic rapidly refilling HH despite adequate dietary sodium restriction and maximum tolerated diuretic dose[107].
尽管有足够的膳食钠限制和最大耐受利尿剂剂量[107],但约20%-25%的HH患者有持续症状性快速再灌注性HH。
 
 Early liver transplantation is the only curative treatment for these patients, but it is not always available because of recipient condition and limited donor availability.
早期肝移植是这些患者的唯一治疗方法,但由于受体条件和供体可用性有限,它并不总是可行的。
 
 Therapeutic thoracentesis can be offered as an alternative for symptomatic relief.
治疗性胸腔穿刺术可作为一种症状缓解的替代选择。
 
 However, therapeutic thoracentesis is not recommended as a long-term treatment due to the risk of re-expansion pulmonary edema, pneumothorax, bleeding, and infection.
然而,由于有再扩张性肺水肿、气胸、出血和感染的风险,因此不推荐使用治疗性胸腔穿刺术作为长期治疗方法。
 
TIPS effectively reduce the portal pressure, thereby providing symptomatic relief in close to 2/3rds of patients[108,109].
TIPS可有效降低门脉压,从而缓解近2/3rds的[108,109]患者的症状。
 
However, since HH is relatively uncommon, controlled studies assessing the role of TIPS for this condition are lacking.
然而,由于HH相对少见,因此缺乏评估TIPS在这种情况下的作用的对照研究。
 
 Recently, Ditah et al[110] and colleagues conducted a systematic review and meta-analysis of 6 retrospective studies involving a total of 198 patients suffering from HH.
最近,Ditah等人[110]和同事对6项涉及198例HH患者的回顾性研究进行了系统综述和荟萃分析。
 
 The analysis of pooled data showed that TIPS was successful in relieving the symptoms in 73% of cases, with complete response seen in 56% of patients.
对汇总数据的分析显示,TIPS可成功缓解了症状,56%的患者完全缓解。
 
The occurrence of HE and overall mortality was found to fall within the observed range, as seen with TIPS performed for other established indications.
HE的发生和总体死亡率在观察范围内,与对其他既定适应症进行的TIPS一样。
 
In the absence of controlled studies comparing TIPS with standard medical treatment, the benefit of TIPS on TFS in HH cannot be commented upon.
在缺乏比较TIPS与标准药物治疗的对照研究的情况下,TIPS对HH患者TFS的益处不能被评论。
 
 In a recent retrospective single-center analysis, despite the selection of patients with lower mean CTP (9.9 ± 1.6) and MELD score (18.7 ± 5.4), the 6-mo mortality after TIPS for HH was close to 36%[111].

在最近的一项回顾性单中心分析中,尽管选择了较低的平均CTP(9.9±1.6)和MELD评分(18.7±5.4)的患者,HHTIPS后6个月的死亡率接近36%[111]。

The independent predictors of mortality were MELD > 25, spontaneous bacterial peritonitis, and septic shock.
死亡率的独立预测因素为MELD>25、自发性细菌性腹膜炎和脓毒性休克。

The study found no difference in 6 mo mortality and complication rates when TIPS was compared to other treatment groups (standard medical therapy, thoracentesis, and catheter drainage) based on propensity matching analysis. Early TIPS in selected patients may be effective as a bridge to liver transplantation.

该研究发现,基于倾向匹配分析,当TIPS与其他治疗组(标准药物治疗、胸腔穿刺术和导管引流术)相比时,6个月的死亡率和并发症发生率没有差异。选定患者的早期TIPS可能作为肝移植的桥梁有效。
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