肝硬化食管胃静脉曲张出血的内镜下治疗进展

Advances in Endoscopic Treatment of Esophagogastric Variceal Bleeding in Liver Cirrhosis

食管胃静脉曲张(gastroesophageal varices, GOV)是肝硬化常见的并发症之一,由失代偿期门静脉高压导致。一旦破裂出血,则病情凶险,对患者生命威胁极大,因此静脉曲张未破裂时须进行一级预防,防止静脉曲张程度进展、预防出血;若已经破裂出血,则要立即止血,进行二级预防、防止再次出血。在临床诊疗中,内镜下治疗以其与其他治疗方式相比具有有效、经济、普遍等优势,在临床中广泛应用,常用技术包括内镜下套扎术(endoscopic variceal ligation, EVL)、内镜下硬化治疗(endoscopic injection sclerotherapy, EIS)、内镜下氰基丙烯酸酯注射(endoscopic cyanoacrylate in-jection, ECI)等;并且新技术层出不穷,如改良套扎、辅助硬化、EUS引导下氰基丙烯酸酯(cyanoacrylate, CYA)注射、EUS引导下弹簧圈置入及联合治疗等。本文就近年来有关肝硬化GOV内镜下治疗的新技术、新观点综述如下,旨在为临床医师选择患者获益最大的治疗方式时提供参考。

Gastroesophageal varices (GOV) is one of the common complications of liver cirrhosis, caused by portal hypertension during the decompensated phase. Once ruptured and bleeding, the condition is very dangerous and life-threatening to the patients. Therefore, when the varices are not ruptured, primary prevention should be carried out to prevent the progression of varices and bleeding;if the varices have already ruptured and bled, bleeding should be stopped immediately, and secondary prevention should be carried out to prevent re-bleeding. In clinical diagnosis and treatment, endo-scopic treatment is widely used in the clinic due to its advantages of effectiveness, economy and universality compared with other treatment modalities. The commonly used techniques include endoscopic variceal ligation (EVL), endoscopic injection sclerotherapy (EIS), endoscopic cyanoacry-late injection (ECI), etc. and new techniques are emerging, such as modified ligation, assisted scle-rotherapy, EUS-guided cyanoacrylate (CYA) injection, EUS-guided spring coil placement and com-bined treatment. In this article, we summarize the new techniques and opinions on endoscopic treatment of GOV in cirrhosis in recent years, with the aim of providing reference for clinicians to choose the treatment modality with the greatest benefit to patients.