门脉高压食管胃底静脉曲张出血的循证治疗

New Evidence of Therapy for Variceal Haemorrahage in Cirrhosis

肝硬化食管胃底静脉曲张破裂出血的治疗是消化领域最具有挑战性的问题。治疗出血的目的是要找到出血部位止血和预防再出血 ,但有时在治疗上却十分困难。目前有许多治疗门脉高压食管胃底静脉曲张出血的方法 ,包括药物治疗、内镜治疗和分流术。本文介绍有关肝硬化食管胃底静脉曲张破裂出血的治疗的循证医学证据 ,以供临床医师参考。这些证据包括 :①生长抑素、血管收缩素、内镜 (套扎和硬化剂 )和三腔双囊管治疗急性食管胃底静脉曲张破裂出血 ;②药物 (β 受体阻滞剂 )、内镜和外科分流预防原发性食管胃底静脉曲张出血 ;③药物 (β 受体阻滞剂 )、内镜和分流 (外科分流和非外科分流 )预防食管胃底静脉曲张再出血 ;④预防性抗生素的使用。

Variceal bleeding in cirrhosis is one of the most challenging problems in gastroenterology. Bleeding from gastro-oesophageal varices is a main cause of early death (approximately 30%-50% at the first bleeding) in cirrhosis. The aim of our therapy is to locate the place of bleeding, control active bleeding and prevent rebleeding, but it is difficult sometimes. A number of treatment strategies, such as somatostain analogs, vasopressin, endoscopic therapy, transjugular intrahepatic portasystemic shunt (TIPS) have evolved over time, but which is better? New evidence of therapy for variceal haemorrhage will be introduced in Cirrhosis that includes: 1. Somatostatin, vasopressin, ligation, schlerotherapy and balloon tamponade for acute variceal bleeding; 2.β-blockers, ligation, schlerotherapy and shunt surgery for prophylaxis of primary variceal bleeding; 3.β-blockers, ligation, schlerotherapy, shunt surgery and TIPS for prophylaxis of variceal rebleeding; 4. Antibiotic prophylaxis for cirrhosis with gastrointestinal bleeding.