急性上消化道大出血介入治疗现状

Current Interventional Management of Acute Upper Gastrointestinal Bleeding

上消化道出血是一种临床常见的危急重症,其发病率和死亡率均很高。对于血流动力学稳定的患者,内镜评估和治疗仍然是标准治疗方法。然而,药物治疗或联合内镜干预后仍有5%~10%的患者发生严重出血,需要介入或外科治疗。对于非静脉曲张性上消化道出血患者,介入治疗已成为急诊手术治疗的有效替代方案,也是目前公认内镜治疗失败后的一线治疗方法。肝硬化患者Child-Pugh C级或B级合并内镜检查中静脉曲张、活动性出血,存在较高的治疗失败、再出血和死亡风险。经颈静脉肝内门静脉分流术已被证明可以显著减少此类患者治疗失败和死亡率。本文拟结合四川大学华西医院消化内科多年的临床经验,简述介入治疗在急性上消化道大出血临床干预中的作用。

Upper gastrointestinal bleeding(UGIB),a common medical emergency,causes significant morbidity and mortality.Endoscopic evaluation and treatment remain the standard care in patients who can be hemodynamically stabilized.However,severe bleeding despite conservative medication treatment or medication combined with endoscopic intervention occurs in 5%-10%of patients,requiring interventional or surgical treatment.Endovascular embolization has emerged as an alternative to emergency operative intervention for high-risk patients with non-variceal UGIB and is now commonly considered the first-line therapy for refractory bleeding after endoscopic treatment.Child-Pugh class C or class B cirrhosis patients who have varicosity or active bleeding detected in endoscopy are at high risks for treatment failure,rebleeding,and death.A preemptive transjugular intrahepatic portosystemic shunt has been shown to reduce treatment failure and mortality significantly.Herein,we reviewed the current role of interventional treatment in the management of massive UGIB on the basis of years of clinical experience of the Department of Gastroenterology,West China Hospital,Sichuan University.