2017年 · 第51卷第05期

Since the early 1990s, transjugular intrahepatic portosystemic shunt (TIPS) was first used in the treatment of cirrhotic portal hypertension in China^[1]After nearly 25 years of development, great progress has been made in the technical specifications, indication selection and prevention and control of concurrent certification of TIPS. In 2004, the editorial board of Chinese Journal of Radiology organized more than 20 relevant experts to write the clinical technical guidelines for transjugular intrahepatic portosystemic shunt^[2]It has played an important guiding role in promoting and standardizing the application of TIPS technology and improving the clinical efficacy of this technology. Postoperative stent dysfunction and hepatic encephalopathy are the main reasons that hinder the widespread application of TIPS for a long time. The emergence of covered stents has brought the clinical application of TIPS into a new era, and the incidence of stent dysfunction has decreased from 44% to 13%^[3]。 In the past 10 years, studies have further confirmed the efficacy of TIPS in the treatment of portal hypertension complications and liver vascular diseases. In 2010, the American Society of Hepatology updated the guidelines of TIPS^[4]In 2014, the Digestive Intervention Group of the Gastroenterology Branch of the Chinese Medical Association issued a consensus opinion on the treatment of portal hypertension in cirrhosis through jugular intrahepatic portosystemic shunt^[5], the 2015 Baveno VI portal hypertension guidelines also updated some of them^[6]。 Although many institutions have regulated TIPS technology, there are still many clinical issues that are still controversial. Therefore, the Interventional Group of Radiology Branch of Chinese Medical Association and the Editorial Board of Chinese Journal of Radiology jointly organized many discussions with relevant experts, and once again wrote and published this edition of TIPS expert consensus. On the basis of summarizing the latest progress at home and abroad and combining with China's national conditions, the grading of recommendations assessment development and evaluation (GRADE) system is adopted for grading, which is based on literature evidence and flexible, and is of great significance to guide the rational application of TIPS in China at present stage and grasp the latest progress.

In recent 20 years, the incidence of type 2 diabetes mellitus (T2DM) has increased sharply. Studies have shown that due to the impairment of subcutaneous fat storage capacity in T2DM patients, a large amount of fat accumulates in ectopic tissues such as liver, pancreas, kidney, myocardium, skeletal muscle and bone marrow, forming ectopic fat deposition^[1,2,3]。 Ectopic lipid deposition produces a large amount of lipotoxic substances, which further aggravates tissue insulin resistance and forms a vicious circle, while redistribution of ectopic fat to subcutaneous adipose tissue can reduce organ insulin resistance^[1]。 Therefore, it is important to understand the distribution of adipose tissue and quantitatively analyze ectopic fat deposition.