| Rescue TIPS 和Early TIPS作为一种预防出血的治疗不同，Rescue TIPS 主要用于内科治疗失败的患者进行抢救性治疗。如尽管使用 1. 血管活性药物（NSBB）非选择性β受体阻滞剂 non-selective β blocker NSBB 2. 静脉曲张结扎术（esophageal varices ligation,EVL） 3. 预防性抗生素 仍有高达10%~15%的患者持续出血或早期再出血。在这种情况下,TPS应该作为首选的抢救治疗方法。在临床上，这种情况主要针对肝功能Child-Pugh A级经药物和内镜治疗失败的急性出血，主要因为Child A级 这类病人比较多。事实上Child B或C也不是内镜、血管活性药物，及食道静脉结扎的禁忌症，B或C级患者内科治疗失败后，也适合 Rescute TIPS 治疗 内镜治疗后危机生命大出血发生率 In patients with liver cirrhosis, acute variceal [ˌværɪ'siəl] bleeding has a considerable risk of death. Mortality increases dramatically if bleeding persists or early rebleeding occurs after endoscopic and drug treatments have been applied. This almost fatal [ˈfeɪtl] situation occurs in 10–20% of patients with variceal bleeding which are now candidates ['kændɪdeɪts] for treatment with the transjugular intrahepatic portosystemic shunt (TIPS) 【1，2】 至少在2017年以前的文献（多数是队列研究）仍然不清楚 Rescue TIPS是否获益，仍然有比例再出血 Numerous cohort [ˈkəʊhɔ:t] studies (3-10) have been performed in the past to evaluate the benefit of rescue TIPS. They predominantly included patients in Child-Pugh class B and C and the technical success rate was close to 100%. Primary hemostasis [ˌhi:mə'steɪsɪs] was achieved in almost all patients but 16% to 30% rebled mostly from ulcers due to previous endoscopic treatments. The 30-day mortality ranged between 17% and 55%. Since studies were not comparative and mortality after rescue TIPS is considerable, the benefit of this measure remains obscure. (编辑：Mr.Editor) |