[Research advances on hepatic encephalopathy following transjugular intrahepatic portosystemic shunt].

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) is an important therapeutic method for complications of portal hypertension in cirrhosis, but the high incidence rate of postoperative hepatic encephalopathy seriously affects patient prognosis. Current research focuses on the core mechanisms and intervention methods specific to or related to TIPS, clarifying that the risk factors for hepatic encephalopathy are centered on perioperative TIPS parameters (stent diameter, portosystemic venous pressure gradient, spontaneous portosystemic shunt). The pathogenesis is key to shunt-related ammonia metabolism imbalance, hemodynamic abnormalities, and gut-hepatic-brain axis abnormalities. Prevention and treatment strategies revolve around a comprehensive management system of "preoperative risk stratification-intraoperative precise shunt-postoperative targeted intervention," emphasizing TIPS-specific procedures such as stent optimization, spontaneous portosystemic shunt closure, and flow-limiting stents, as well as targeted technologies like fecal microbiota transplantation and artificial intelligence risk prediction, ultimately providing practical evidence for the precise prevention and treatment of hepatic encephalopathy following TIPS.