肝硬化门脉高压症内科治疗的选择与评价

Evaluation on treatment of liver cirrhosis with portal hypertension

心得安推荐作为预防Child A或B级肝硬化患者中-重度静脉曲张初次出血;生长抑素及其类似物为急性食管胃底静脉曲张出血(EVB)的首选药物,控制出血疗效85%-90%;心得安或联合5-单硝异山梨醇、内镜下套扎或硬化剂可作为预防静脉曲张再出血的方法;经颈静脉肝内门腔分流术(TIPS)仅为Child B或C级患者准备肝脏移植的过度.内科联合治疗方法的评价需要循症医学的证据,轻度静脉曲张及早期门脉高压的治疗策略仍需要进一步研究.

Gastroesophageal variceal bleeding （EVB） is a frequent and life-threatening complication in cirrhotic patients with portal hypertension. Despite advances in endoscopic and pharmacologic treatment for EVB, it remains an unacceptably high mortality and risk of rebleeding. For primary and secondary prevention of EVB, non-surgical treatment strategies are still particularly challenging. Nonselective beta blockade, propranolol, is considered the first choice in the primary prophylaxis of EVB. Somatostatin and its analogue, octreotide, have been used as first-line treatment for EVB. The rate of controlling EVB accounts for 85%-90%, pituitrin, a vasopressin has essentially been abandoned because of side effects. Available treatments for prevention of rebleeding have been recommended, such as the beta blockers, nitrates （especially used in combination With beta blockers）, and mechanical therapies such as endoscopic sclerotherapy/band ligation and transjugular intrahepatic portosystemic shunt （TIPS）. TIPS should not be used as a first-line treatment for EVB, but as a rescue for medical or endoscopic treatment failure. The evaluations on combination of nonsurgical treatment for EVB are still not more evidence-based medical trails. The clinical studies on treatment for slight varices and early portal hypertension are positively needed.