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高,这可能是因为TIPS术后门体分流道的存在导致 tions and strategies to improve the outcomes[J]. Intern
入肝血流减少,并对患者的肝功能有所影响 [15] 。此 Emerg Med,2020,15(1):37-48
外,TIPS 手术并不能延缓患者的自身免疫性损伤, [7] HENNES E M,ZENIYA M,CZAJA A J,et al. Simplified
其肝硬化进程不可逆转 。本研究中患者术后3个 criteria for the diagnosis of autoimmune hepatitis[J].
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月的胆红素水平较术前并无显著上升,可能与术后
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联合口服熊去氧胆酸治疗有关。
guidance:the diagnosis and management of patients with
在术后并发症方面,1 例患者术后短期出现了
primary biliary cholangitis[J]. Hepatol Int,2022,16(1):
腹腔出血,考虑与术中穿刺损伤门静脉周围血管有 1-23
关,术后监测生命体征,及时发现出血并处理后好 [9] NGUYEN H H,SHAHEEN A A,BAEZA N,et al. Evalua⁃
转出院。1 例患者术后出现急性心功能不全,可能 tion of classical and novel autoantibodies for the diagno⁃
为术后分流道增加回心血量所致。在长期随访中,肝 sis of primary biliary cholangitis ⁃ autoimmune hepatitis
性脑病发生率为17.4%,略低于其他病因引起失代偿 overlap syndrome(PBC⁃AIH OS)[J]. PLoS One,2018,13
期肝硬化经TIPS治疗的报道(24%~53%) 。本研究 (3):e0193960
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中所有患者术后均无分流道或支架功能障碍。这 [10] ROSE C F,AMODIO P,BAJAJ J S,et al. Hepatic enceph⁃
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可能是因为本研究中使用的支架均为 Viatorr 专用
gy and therapy[J]. J Hepatol,2020,73(6):1526-1547
支架,其与裸支架相比,具有更高的分流道通畅率,
[11] LUO X,ZHAO M,WANG X,et al. Long ⁃ term patency
且不会增加肝性脑病的发生率 。
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and clinical outcome of the transjugular intrahepatic por⁃
本研究还存在一定局限性。首先,这是一项针对 tosystemic shunt using the expanded polytetrafluoroethyl⁃
少数患者的回顾性研究,无法进一步进行分层分析。 ene stent⁃graft[J]. PLoS One,2019,14(2):e0212658
其次,原发性硬化性胆管炎的患者并没有纳入本研究。 [12] YOUNG S,BERMUDEZ J,ZHANG L,et al. Transjugular
综上所述,本研究表明 TIPS 联合 PTVE 治疗 intrahepatic portosystemic shunt(TIPS)placement:a com⁃
AILD 后肝硬化患者的食管胃底曲张静脉破裂出血 parison of outcomes between patients with hepatic hydro⁃
可能是安全有效的。 thorax and patients with refractory ascites[J]. Diagn In⁃
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