门静脉高压内镜治疗的现状与展望

Endoscopic treatment of portal hypertension:current status and future prospects

内镜治疗作为门脉高压食管胃静脉曲张控制出血与预防再出血的主要治疗手段,近年来内镜下食管胃静脉曲张的诊疗不断地走向个体化、精准、全程管理模式。通过病史、体检、实验室和影像学等检查可以准确判断门脉高压病因与临床特点,重视门脉高压的病因诊断处理可以更有效控制静脉曲张的进展。静脉曲张分型复杂,依据内镜、增强CT门脉重建、肝静脉压力梯度测定等检查结果进行个体化分层分级评估选择方案,结合改良组织胶治疗技术精准治疗是提高疗效、减少并发症的关键。关注门脉高压其他并发症与患者合并疾病,联合多学科诊疗管理,及时综合处理,是改善门脉高压患者内镜治疗疗效和预后的关键。

Endoscopic treat menl is the main therapy for controlling variceal bleeding and secondaiy prophylaxis of rebleeding of gastroesophageal varices of portal hypertension.Endoscopic treatment of gastroesophageal varices are developing towards individualization,precision and whole management in recent years.We can diagnose the etiology and characteristic of portal hypertension through medical history,physical examination,laboratory and radiological tests.It is important to identify the etiology of portal hypertension that can control the progress of varices.There is a complex classification of varices.Individualized stratification and treatment selection are based on the results of endoscopic finding,contrast computed tomography(CT),hepatic venous pressure gradient,etc.Modified precise endoscopic injection of cyanoacrylate is important part to improve the efficacy and reduce the complications of endoscopic treatment.We need to pay attention to the complications and comorbidities of portal hypertension,comprehensive management with the multidisciplinary teams,that is the most important thing to improve the efficacy of endoscopic treatment and the prognosis of patients with portal hypertension.