| Extrahepatic surgery is associated with higher postoperative morbidity and mortality in patients with cirrhosis[137]. 肝外手术与肝硬化[137]患者术后发病率和死亡率较高相关。 The reported mortality is between 10% to 30%, while the perioperative morbidity is about 30%. 报告的死亡率为10%-30%之间，而围手术期的发病率约为30%。 The outcome is mainly influenced by the severity of liver disease, type of surgery, and the degree of PH[138,139]. 其结果主要受肝病的严重程度、手术类型和PH[138,139]的程度的影响。 Pre-operative TIPS may reduce the portal pressure and decrease the risk of bleeding as well as help in managing pre-or-post operative ascites[140-147]. 术前TIPS可降低门静脉压，降低出血的风险，并有助于处理术前或术后的腹水[140-147]。 The optimal time between TIPS and the performance of surgery is controversial. TIPS和手术性能之间的最佳时间存在争议。 Nonetheless, a delay of 1 mo from TIPS to surgery has been suggested to be the most appropriate for optimal portal decompression[142]. 尽管如此，从TIPS到手术延迟1个月被认为是最适合最佳门静脉减压[142]。 That being, the perceived benefit of TIPS must be weighed against the risk of the procedure itself and the associated time delay. 也就是说，TIPS的感知利益必须与程序本身的风险和相关的时间延迟相权衡。 All publications on the role of pre-operative TIPS are retrospective in the form of single clinical reports or case series with a fairly small number of patients[140-147]. 所有关于术前TIPS作用的出版物均以回顾性的单一临床报告或病例系列的形式发表，患者数量较少[140-147]。 Out of these, only two studies have had a control group, but both were retrospective comparative studies without randomization[143,146]. 其中，只有两项研究有对照组，但都是无随机性[143,146]的回顾性比较研究。 A systematic analysis of all the published data showed that there is marked heterogeneity with regards to patient selection based on the severity of the underlying liver disease, indication for TIPS, criteria for successful TIPS, and time-lapse between TIPS placement and surgical procedure[148]. 对所有已发表数据的系统分析显示，基于潜在肝病的严重程度、TIPS的适应症、TIPS成功的标准以及TIPS放置与手术[148]之间的时间间隔的患者选择存在显著的异质性。 The study by Vinet et al[143] compared patients who underwent an elective abdominal surgery after preoperative TIPS placement (n = 18) with those who underwent surgery without TIPS (n = 17) during the same period. Vinet等[143]的研究比较了术前TIPS放置后接受选择性腹部手术的患者（=18）和同期未接受TIPS手术的患者（=17）。 The authors found that the preoperative portal decompression with TIPS did not improve outcome after abdominal surgery in patients with cirrhosis. 作者发现，术前使用TIPS进行门静脉减压并不能改善肝硬化患者腹部术后的预后。 However, the TIPS group in this study had a higher mean CTP score compared to the control group. 然而，本研究中TIPS组的平均CTP得分高于对照组。 The other retrospective, multi-institutional, comparative study by Tabchouri et al[146] also did not find any significant differences between TIPS and control groups in terms of severe postoperative complications and mortality. Tabchouri等人[146]的另一项回顾性、多机构、比较研究也发现TIPS组和对照组在术后严重并发症和死亡率方面没有任何显著差异。 Notably, they found deterioration of hepatocellular function after TIPS placement, which persisted postoperatively despite a mean interval of 51 d between TIPS placement and planned surgery. 值得注意的是，他们发现TIPS放置后肝细胞功能恶化，尽管TIPS放置和计划手术之间平均间隔51天，但术后仍持续51天。 In this study, a subset of patients with less severe PHT (HVPG ≤ 13 mmHg) and less advanced liver dysfunction (MELD-sodium score ≤ 15) seemed to benefit from preoperative TIPS placement in terms of postsurgical complications in the absence of statistical significance. 在这项研究中，一些PHT(HVPG≤13mmHg)和较低晚期肝功能障碍(meld-钠评分≤15)的患者似乎在没有统计学意义的情况下，从术前放置术后并发症中获益。 Contrarily, in the study by Kim et al[144], despite a preoperative mean MELD score of 15 among the patients (n = 6), the 1-year survival rate was 74%. 相反，在Kim等人[144]的研究中，尽管患者术前平均MELD评分得分为15(n=6)，但1年生存率为74%。 A recent prospective study showed the value of HVPG in predicting outcomes in cirrhosis patients undergoing non-hepatic surgery, with no patient having HVPG < 10 mmHg or indocyanine green clearance > 0.63 developing decompensation[149]. 最近的一项前瞻性研究显示，HVPG在预测非肝手术患者预后方面的价值，没有患者HVPG为10mmmg或紫青清除率为0.63发展失补偿[149]。 On the other hand, HVPG > 16 mmHg was independently associated with higher mortality, and patients with HVPG > 20 mmHg were found to be at the highest risk. 另一方面，HVPG＞16mmHg与较高的死亡率独立相关，而HVPG&＞20mmHg患者的风险最高。 Interestingly, MELD and CTP scores were not independent predictors of post-surgical mortality. 有趣的是，MELD和CTP评分并不是术后死亡率的独立预测因素。 The findings of this study reiterate that the potential of pre-surgical TIPS in high-risk patients deserves further research to improve outcomes. 本研究结果重申，术前TIPS对高危患者的应用潜力值得进一步研究，以改善预后。 Based on all the available published evidence, routine TIPS placement cannot be recommended before surgical procedures in all patients with cirrhosis and PH. 基于所有已发表的证据，不能推荐所有肝硬化和PH患者在手术前常规放置TIPS。 Pre-operative TIPS is likely to benefit cirrhosis patients having preserved liver function but with features of severe PH who are undergoing curative oncosurgery. 术前TIPS可能有利于肝功能储备，但有严重门静脉高压特征的肝硬化患者治愈性肿瘤外科。 |