肝硬化患者静脉曲张和静脉曲张出血的处理

Management of Varices and Variceal Hemorrhage in Patients with Liver Cirrhosis

肝硬化包括两个主要阶段:代偿期和失代偿期,其中失代偿期死亡率较高。腹水、静脉曲张出血、肝性脑病是肝硬化失代偿期的标志,由门脉高压引起。代偿期肝硬化患者的治疗方法和管理主要集中在内镜下高危静脉曲张患者出血的预防。最近的研究表明,对于肝硬化和临床意义显著的门静脉高压患者中,通过非侵入性措施如肝硬度和血小板计数,可以预测包括静脉出血在内的所有失代偿事件的发生。在这些患者中,非选择性β受体阻滞剂已被证明可以预防腹水生成和静脉曲张生长。在本综述中,概述了肝硬化风险分层,门脉高压的定义,代偿期肝硬化伴门脉高压的治疗,急性静脉曲张出血的治疗以及静脉曲张出血复发的预防策略。

Cirrhosis consists of two main stages: compensated and decompensated, and the latter has a higher mortality. Variceal hemorrhage, together with ascites or encephalopathy, or both, is events that de-fine cirrhosis decompensation and are driven by portal hypertension. The approach and manage-ment of patients with compensated cirrhosis have been mostly focused on preventing variceal hemorrhage in those who have high-risk varices on endoscopy. Recent studies suggest a paradigm shift aimed at preventing all decompensating events, not only variceal hemorrhage, in patients with cirrhosis and clinically significant portal hypertension identified via noninvasive measures such as liver stiffness and platelet count. In these patients, nonselective beta-blockers have been shown to prevent ascites and variceal growth. In this review, we provide an overview of risk stratification of cirrhosis, definition of portal hypertension, management of compensated cirrhosis with portal hy-pertension and the management of acute variceal hemorrhage as well as prevention strategies for variceal hemorrhage recurrence.