Optimal stent diameter The 8-mm vs 10-mm debate: The availability of covered stents for TIPS has significantly reduced the incidence of stent dysfunction with attendant improvement in patient outcomes[206].
最佳支架直径 8mm和10mm的争论：覆盖支架的应用显著降低了支架功能障碍的发生率，并伴随着患者预后的改善[206]。
While covered stents have become the standard of care for TIPS world over, the question of optimal stent diameter for TIPS remains unanswered. The diameter of the stent determines the amount of portal blood shunted into the systemic circulation and the PSPG. Several studies have found a relationship between the degree of portosystemic shunting and post TIPS HE[172]. Similarly, a lower PSPG has also been identified as a risk factor for HE after TIPS[207,208].
虽然覆膜支架已成为世界各地TIPS的标准，但覆膜支架理想直径的问题仍未得到解答。支架的直径决定了门脉血液分流到体循环和肺的数量。一些研究发现了门系统分流的程度与[172]后TIPS之间的关系。同样地，较低PSPG也被证明是TIPS术后肝性脑病[207,208]的一个危险因素。
Also, impairment of hepatic function often seen after TIPS could be reduced by decreasing the size of the stent to avoid significant portal flow diversion and maintain sufficient hepatic perfusion.
此外，TIPS后通常可以通过减少支架的大小来减少肝功能的损害，以避免明显的门静脉分流和维持足够的肝灌注。
According to Poiseuille's law, shunt flow is proportional to the fourth power of the stent radius.
根据波泽尔定律，分流流量与支架半径的第四次功率成正比。
This underlines the impact of small variations of the stent diameter on shunt flow and, eventually, shunt-related complications.
这强调了支架直径的微小变化对分流流量的影响，并最终导致分流相关的并发症。
Thus, the use of a smaller diameter stent is desirable.
因此，需要使用较小直径的支架。
However, placement of smaller diameter stent runs the risk of not achieving adequate portal pressure reduction defeating the purpose for which TIPS was done.
然而，放置较小直径的支架会有无法实现足够的门静脉减压的风险，从而无法达到完成TIPS的目的。
The earliest RCT comparing 8-mm and 10-mm covered stents for TIPS had to be stoped early after the results in the first 45 patients showed significantly less efficient control of complications of PH in the patients receiving 8-mm stents[94].
最早的比较8mm和10mm覆盖支架的随机对照试验，不得不尽早停止，因为前45例患者的结果显示，接受8mm支架[94]的患者对PH并发症的有效控制明显较低。
Due to the premature closure of the study, the trial could not provide any evidence on the risk of development of HE.
由于研究的过早结束，该试验不能提供任何关于HE发展风险的证据。
Contrarily, another randomized multicentre trial from Germany comparing covered 8-mm diameter TIPS with HVPG-guided medical therapy for prophylaxis of rebleeding from EV showed that TIPS prevented variceal rebleeding more effectively than drugs without any improvement in survival or quality of life[26].
相反，另一项来自德国的随机多中心试验比较了覆盖8毫米直径的TIPS和HVPG引导的药物治疗预防EV再出血，表明TIPS比药物更有效地预防静脉曲张再出血，而没有改善生存或生活质量[26]。
Compared to other studies using covered TIPS stents, the two-year incidence of overt encephalopathy in the TIPS group in this study was low at 18%.
与其他使用覆膜TIPS支架的研究相比，本研究中TIPS组两年显性脑病发生率较低，为18%。
However, the patients included in this study had rather compensated liver disease (Child A or B cirrhosis), and there was no head-to-head comparison between 8-mm and 10-mm stents.
然而，本研究纳入的患者有相当多的代偿性肝病(Child-PughA或B型肝硬化)，并且在8mm和10mm支架之间没有头对头的比较。
Notably, only 43% of patients in the TIPS group had a reduction of PSPG below 10 mmHg.
值得注意的是，TIPS组中只有43%的患者将PSPG降低到10mmHg以下。
TIPS revisions were required in 8% of the patients with PSPG < 10 mmHg and in 29% of patients with PSPG ≥ 10 mmHg.
8%的PSPG＜10mmHg患者和29%的PSPG≥10mmHg患者需要进行TIPS修订。
Nevertheless, a recent RCT from China of 127 patients found that 8 mm covered TIPS stents showed similar shunt function to 10-mm stents, with the halved risk of spontaneous overt HE and less hepatic function impairment[209].
然而，最近来自中国的一项127例患者的随机对照试验发现，8mm覆盖的TIPS支架显示出与10mm支架相似的分流功能，自发性明显HE的风险为一半，肝功能损害[209]较少。
Notably, the majority of patients in this study had hepatitis-B as the etiology of cirrhosis, which is different from the earlier study by Sauerbruch et al[26], in which more than 60% of patients had alcoholic cirrhosis.
值得注意的是，本研究中的大多数患者以乙型肝炎为肝硬化的病因，这与Sauerbruch等[26]的早期研究不同，其中超过60%的患者患有酒精性肝硬化。
Although the stent used for TIPS was Fluency® and not Viatorr®, the same stent was used in both groups and might not have influenced the outcomes.
虽然用于TIPS的支架是 Fluency®，而不是Viatorr®，但两组均使用了相同的支架，可能不会影响结果。
Whether the trend towards beneficial effects of 8-mm stents could be extended to patients receiving TIPS for RA is unclear.
8mm支架的有益效果趋势是否可以扩展到接受TIPS治疗RA的患者尚不清楚。
A retrospective study of 171 patients in this regard showed that 10-mm covered stents for TIPS resulted in better control of ascites compared to an 8-mm stent without increasing the incidence of HE[95].
一项对171例患者的回顾性研究显示，与8mm支架相比，10mm覆膜的TIPS支架可以更好地控制腹水，而没有增加HE[95]的发生率。
They found that the mean PSPG after TIPS was significantly higher in the 8-mm stent group than in the 10-mm stent group, and in the overall study cohort, the need for paracentesis was associated with a higher PSPG.
他们发现，8mm支架组的TIPS后的平均PSPG明显高于10mm支架组，并且在整个研究队列中，腹水穿刺的需要与较高的PSPG相关。
Another recent analysis of 185 patients from the German TIPS registry showed that patients receiving 8-mm stents had prolonged survival compared to those receiving 10-mm stents[210].
另一项最近对来自德国TIPS注册的185例患者的分析显示，与接受10mm支架[210]的患者相比，接受8mm支架的患者的生存期延长。
However, in this study, 8-mm stents were used more frequently in patients with variceal bleeding, while 10-mm stents were placed more commonly in patients having RA.
然而，在本研究中，8mm支架在静脉曲张出血患者中更常用，而10mm支架在RA患者中更常见。
Since patients with RA are generally at a more advanced stage of liver cirrhosis than those with variceal bleeding, derivation of any robust conclusion on survival benefit is not possible from this study.
由于RA患者通常比静脉曲张出血患者肝硬化更晚期，因此本研究不可能得出任何关于生存获益的可靠结论。
Moreover, although patients in the two groups were matched for age, MELD score, and serum bilirubin concentration, they remained different concerning CTP score and creatinine concentration.
此外，虽然两组患者的年龄、MELD评分和血清胆红素浓度均相匹配，但他们在CTP评分和肌酐浓度方面仍存在差异。
Thus, the 10 mm group had more patients with Child C cirrhosis, and the mean creatinine concentration of patients in this group was higher.
因此，10mm组的Child-C型肝硬化患者较多，该组患者的平均肌酐浓度较高。
Other confounding factors affecting survival like sarcopenia were not available for analysis, and the incidence of HE in both groups was not compared.
其他影响生存的混杂因素，如骨骼肌减少症，无法进行分析，两组均未比较HE的发生率。
The incidence of rebleeding and recurrence of ascites was also not analyzed in this study.
本研究也未分析再出血和腹水复发的发生率。
Thus, comparisons on the clinical efficacy of TIPS in both groups of patients cannot be drawn and properly matched patient cohort with adequate sub-group analysis followed by quality prospective studies remain an unmet need to clarify the current issue at hand.
因此，无法比较两组患者的临床疗效，并对适当匹配的患者队列进行适当的亚组分析，然后进行高质量的前瞻性研究，但仍需要澄清当前的问题。
Notably, 8-mm stents resulted in less reduction of the PSPG (45% vs 65%) compared to 10-mm stents, and patients with an 8-mm stent required significantly more revisions.
值得注意的是，与10mm支架相比，8mm支架导致PSPG的减少更少(45%vs65%)，而使用8mm支架的患者需要明显更多的修订。
Current evidence is inadequate to recommend routine use of smaller diameter stents in all patients.
目前的证据不足以建议所有患者常规使用较小直径的支架。
However, in patients who are at higher risk of development of HE or liver failure, especially when TIPS is used in the setting of acute variceal bleeding, there may be a role of 8-mm stents.
然而，在HE或肝衰竭风险较高的患者中，特别是当TIPS用于急性静脉曲张出血时，8mm支架可能有作用。
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