食管静脉曲张再发出血的防治进展

• 作 者: 董正芳 孟庆平 程留芳
• 机 构: 辽河油田中心医院消化内科,辽河油田井下作业公司,解放军总医院消化内科 辽宁盘锦124010,辽宁盘锦124010,北京100859
• 出 处: 医学综述
• 发表日期: 2007年12期
• 关键词: 食管静脉曲张 门静脉高压 非选择性β受体拮抗剂 内镜下静脉曲张硬化疗法 内镜下静脉曲张套扎治疗 经颈静脉肝内门脉系统分流术

食管静脉曲张出血的患者在急诊出血得到控制后仍有很高的再发出血率,其病死率高,因此必须预防再发出血。目前有多种方法预防再发出血,迄今为止,并没有一个标准化方案,各种方法联合应用更可取。单独应用非选择性β受体阻滞剂或与硝酸酯类和内镜治疗联合应用临床疗效可靠,尤其是非选择性β受体阻滞剂与内镜介入治疗联合应用疗效更佳。药物与内镜介入疗法失败后,经颈静脉肝内门脉系统分流低病死率,经颈静脉肝内门脉系统分流术逐渐取代常规分流术。随着肝移植技术的发展,肝移植作为食管静脉曲张再发出血的治疗方法应被提上日程。

Patients with esophageal variceal bleeding still have a high rate of recurrent haemorrhage after emergency bleeding is controlled, and their mortality is high, so the need to prevent the recurrence of bleeding. There are many ways to prevent the recurrence of bleeding, so far, there is no standardized solution, a combination of various methods is preferable. Non-selective β-blocker alone or in combination with nitrates and endoscopic treatment of clinical efficacy and reliable, in particular, non-selective β-blockers and endoscopic interventional treatment combined with better. After drug and endoscopic intervention failed, the transcatheter hepatic portal venous system shunt low mortality, and gradually replaced routine shunt via jugular vein portal system. With the development of liver transplantation, liver transplantation as bleeding esophageal varices should be put on the agenda.