肝硬化食管胃底静脉曲张破裂出血的综合治疗

Comprehensive treatment of esophogastric variceal bleeding secondary to liver cirrhosis

食道胃底静脉曲张破裂出血是肝硬化的严重致死性并发症之一。门脉压力增高与食道胃底曲张静脉破损是其发生的必备条件及主要风险因素,其临床治疗方法涉及药物、内镜、介入、手术及肝移植,优势各异。笔者从门静脉压力、曲张静脉破损及肝功能损害等风险因素控制的角度,分析评估了目前其各种临床治疗方法的临床效果及作用机制。控制单一风险因素的治疗方法的临床效果往往有限,而对多种风险因素进行联合控制的综合治疗方案具有较好的临床疗效。内镜结合脾动脉主干栓塞的联合治疗方案具备优于其它治疗方案的理论优势。

Esophogastric variceal bleeding is one of the severe and lethal complications of liver cirrhosis, and portal hypertension and esophogastric variceal vein damage are essential and main risk factors for its occurrence. Its clinical treatment includes medications, endoscopic or interventional therapy, surgery and liver transplantation, each with specific advantages. From the perspectives of control of the risk factors such as portal vein pressure, varicose vein damage and liver function injury, the authors analyzed and evaluated the clinical effect and mechanism of various clinical treatment methods. The clinical effect of single risk factor control is often limited, while the combined treatment for multiple control of the risk factors has better clinical efficacy. Furthermore, endoscopy combined with splenic arterial trunk embolization has theoretical advantages over other treatment options.