肝硬化伴胃静脉曲张内镜下治疗进展

Progress in endoscopic treatment of gastric varices in patients with liver cirrhosis

肝硬化定义为一种或多种病因长期或反复作用形成的弥漫性肝损害.当肝硬化进展至失代偿期时,其主要表现为肝功能损害和门脉高压.门脉高压主要表现形式主要有侧枝循环、脾大、腹水等.其中胃静脉曲张(gastric varice,GV)为侧枝循环中最常见表现形式之一,胃静脉曲张破裂出血(gastric varices rupture and bleeding,GVB)同时为肝硬化最常见并发症之一,其死亡率较高.近年关于GV的研究较多,但不同类型GV的内镜治疗方案选择尚存在争议,且与食管静脉曲张(esophageal varices,EV)相比,GV具有出血量大、病情凶险及高死亡率的特点,因此选择一种合适的内镜治疗方法,将有效减少死亡率和改善预后.本文就GV的分型和不同类型GV的内镜治疗进行综述.

Cirrhosis is defined as diffuse or prolonged hepatic damage caused by one or more etiologies. When liver cirrhosis progresses to decompensation stage, hepatic dysfunction and portal hypertension are the main manifestations. Main symptoms of portal hypertension include collateral circulation, splenomegaly, and ascites. Gastric varices （GV） is one of the most common manifestations of collateral circulation. Gastric variceal bleeding （GVB） is one of the most common complications of cirrhosis, with a high mortality rate. In recent years, there are many studies on GV, but the choice of endoscopic treatments for different types of GV is still controversial. Compared with esophageal variceal bleeding, GVB is associated with large volume of bleeding, high risk, and high mortality. Therefore, selecting an appropriate endoscopic treatment can effectively reduce mortality and improve the prognosis. This article reviews the＇type of GV and endoscopic treatment of different types of GV.