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Nationwide survey analysis of esophagogastric varices in portal hypertension based on endoscopic management in China
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作者 Xing Wang Bing Hu +33 位作者 Yiling Li Weichun Lin Zhijie Feng Yanjing Gao Zhining Fan Feng Ji Bingrong Liu Jinhai Wang Wenhui Zhang Tong Dang Hong Xu Derun Kong Lili Yuan Liangbi Xu Shengjuan Hu Liangzhi Wen Ping Yao Yunxiao Liang Xiaodong Zhou Huiling Xiang Xiaowei Liu Xiaoquan Huang Yinglei Miao Xiaoliang Zhu De‐An Tian Feihu Bai Jitao Song Ligang Chen Yangzhen Bian Ba Yingcai Ma Yifei Huang Bin Wu Xiaolong Qi CHESS‐Endoscopyconsortium 《Portal Hypertension & Cirrhosis》 2024年第3期129-138,共10页
Aims:The endoscopic treatment of esophagogastric varices is challenging,and the nationwide application of endoscopic therapies for various types of esophagogastric varices and different clinical scenarios remains uncl... Aims:The endoscopic treatment of esophagogastric varices is challenging,and the nationwide application of endoscopic therapies for various types of esophagogastric varices and different clinical scenarios remains unclear.This study investigated the use of endoscopic therapy for portal hypertension in China.Methods:This study used a questionnaire survey initiated by the Liver Health Consortium in China to investigate the use of endoscopic therapies for portal hypertension.Questionnaires were released online from January 30,2023 to February 28,2023 and filled out by chief physicians or senior instructors responsible for endoscopic therapies in participating hospitals across 31 provinces(autonomous regions and municipalities)in China.Comparisons of guideline adherence between primary and referral medical centers were performed using the chi‐square test or Fisher's exact test.Results:In total,836 hospitals participated in the survey.For primary and secondary prophylaxis of esophagogastric variceal bleeding(EGVB),adherence to the national guidelines was 72.5%(606/836)and 39.2%(328/836),respectively.Significant differences were observed in the rate of adherence between the primary and referral centers for primary(79.9%[111/139]vs.71.0%[495/697],p=0.033)and secondary prophylaxis(27.3%[38/139]vs.41.6%[290/697],p=0.002).Of the hospitals,78.2%(654/836)preferred endoscopic therapies for acute EGVB,and the timing of endoscopy was usually within 12 h(48.5%,317/654)and 12-24 h(36.9%,241/654)after bleeding.Endoscopic therapy was more likely to be the first choice of treatment for acute EGVB in referral centers than in primary centers(82.6%[576/697]vs.56.1%[78/139],p<0.001).Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1,the most prevalent procedures were cyanoacrylate injection combined with sclerotherapy(48.2%[403/836]and 29.9%[250/836],respectively);however,substantial hospitals preferred clip-assisted therapies(12.4%[104/836]and 26.4%[221/836],respectively).Nonselective beta‐blockers were routinely used in 73.4%(614/836)of hospitals during the perioperative period of EGVB management,and propranolol(88.8%,545/614)and carvedilol(37.5%,230/614)were the most widely used nonselective beta-blockers.Conclusions:This survey clarified that various endoscopic procedures have been implemented nationwide in China.Participating hospitals have actively performed emergent endoscopy for acute EGVB;however,these hospitals do not adequately follow recommendations regarding primary and secondary prophylaxis of EGVB.In the future,standardizing the selection of endoscopic procedures and improving compliance with guidelines is crucial. 展开更多
关键词 ENDOSCOPY esophagogastric varices guideline adherence portal hypertension questionnaire survey
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Computed tomography-based multi-organ radiomics nomogram model for predicting the risk of esophagogastric variceal bleeding in cirrhosis 被引量:1
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作者 Yu-Jie Peng Xin Liu +3 位作者 Ying Liu Xue Tang Qi-Peng Zhao Yong Du 《World Journal of Gastroenterology》 SCIE CAS 2024年第36期4044-4056,共13页
BACKGROUND Radiomics has been used in the diagnosis of cirrhosis and prediction of its associated complications.However,most current studies predict the risk of esophageal variceal bleeding(EVB)based on image features... BACKGROUND Radiomics has been used in the diagnosis of cirrhosis and prediction of its associated complications.However,most current studies predict the risk of esophageal variceal bleeding(EVB)based on image features at a single level,which results in incomplete data.Few studies have explored the use of global multi-organ radiomics for non-invasive prediction of EVB secondary to cirrhosis.AIM To develop a model based on clinical and multi-organ radiomic features to predict the risk of first-instance secondary EVB in patients with cirrhosis.METHODS In this study,208 patients with cirrhosis were retrospectively evaluated and randomly split into training(n=145)and validation(n=63)cohorts.Three areas were chosen as regions of interest for extraction of multi-organ radiomic features:The whole liver,whole spleen,and lower esophagus–gastric fundus region.In the training cohort,radiomic score(Rad-score)was created by screening radiomic features using the inter-observer and intra-observer correlation coefficients and the least absolute shrinkage and selection operator method.Independent clinical risk factors were selected using multivariate logistic regression analyses.The radiomic features and clinical risk variables were combined to create a new radiomics-clinical model(RC model).The established models were validated using the validation cohort.BACKGROUND Radiomics has been used in the diagnosis of cirrhosis and prediction of its associated complications.However,most current studies predict the risk of esophageal variceal bleeding(EVB)based on image features at a single level,which results in incomplete data.Few studies have explored the use of global multi-organ radiomics for non-invasive prediction of EVB secondary to cirrhosis.AIM To develop a model based on clinical and multi-organ radiomic features to predict the risk of first-instance secondary EVB in patients with cirrhosis.METHODS In this study,208 patients with cirrhosis were retrospectively evaluated and randomly split into training(n=145)and validation(n=63)cohorts.Three areas were chosen as regions of interest for extraction of multi-organ radiomic features:The whole liver,whole spleen,and lower esophagus–gastric fundus region.In the training cohort,radiomic score(Rad-score)was created by screening radiomic features using the inter-observer and intra-observer correlation coefficients and the least absolute shrinkage and selection operator method.Independent clinical risk factors were selected using multivariate logistic regression analyses.The radiomic features and clinical risk variables were combined to create a new radiomics-clinical model(RC model).The established models were validated using the validation cohort.RESULTS The RC model yielded the best predictive performance and accurately predicted the EVB risk of patients with cirrhosis.Ascites,portal vein thrombosis,and plasma prothrombin time were identified as independent clinical risk factors.The area under the receiver operating characteristic curve(AUC)values for the RC model,Rad-score(liver+spleen+esophagus),Rad-score(liver),Rad-score(spleen),Rad-score(esophagus),and clinical model in the training cohort were 0.951,0.930,0.801,0.831,0.864,and 0.727,respectively.The corresponding AUC values in the validation cohort were 0.930,0.886,0.763,0.792,0.857,and 0.692.CONCLUSION In patients with cirrhosis,combined multi-organ radiomics and clinical model can be used to non-invasively predict the probability of the first secondary EVB. 展开更多
关键词 Artificial intelligence CIRRHOSIS Radiomics esophagogastric variceal bleeding
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Transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding in patients with hepatocellular carcinoma and portal vein tumor thrombus
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作者 Zhi-Qiang Wu Fan Wang +4 位作者 Feng-Pin Wang Hong-Jie Cai Song Chen Jian-Yong Yang Wen-Bo Guo 《World Journal of Gastrointestinal Surgery》 SCIE 2024年第9期2778-2786,共9页
BACKGROUND Whether hepatocellular carcinoma(HCC)with portal vein tumor thrombus(PVTT)and acute esophagogastric variceal bleeding(EGVB)can improve the success rate of endoscopic hemostasis and overall survival(OS)from ... BACKGROUND Whether hepatocellular carcinoma(HCC)with portal vein tumor thrombus(PVTT)and acute esophagogastric variceal bleeding(EGVB)can improve the success rate of endoscopic hemostasis and overall survival(OS)from transjugular intrahepatic portosystemic shunt(TIPS)remains controversial.AIM To compare the clinical outcomes between TIPS and standard treatment for such HCC patients.METHODS This monocenter,retrospective cohort study included patients diagnosed as HCC with PVTT and upper gastrointestinal bleeding.Patients were grouped by the treatment(TIPS or standard conservative treatment).The success rate of en-doscopic hemostasis,OS,rebleeding rates,and main causes of death were ana-lyzed.RESULTS Between July 2015 and September 2021,a total of 77 patients(29 with TIPS and 48 with standard treatment)were included.The success rate of endoscopic hemostasis was 96.6%in the TIPS group and 95.8%in the standard treatment group.All the 29 patients in TIPS group successful underwent TIPS procedure and had a better OS compared with standard treatment within the first 160 days after treatment(68 days vs 43 days,P=0.022),but shorter OS after 160 days(298 days vs 472 days, P = 0.022). Cheng’s Classification of PVTT, total bilirubin and Child-Pugh class wereindependently negative associated with OS (all P < 0.05). The main causes of death were liver failure or hepaticencephalopathy (75.9%) in the TIPS group and rebleeding (68.8%) in the standard treatment.CONCLUSIONTIPS could reduce the risk of early death due to rebleeding and prolong short-term survival in HCC patients withPVTT and acute EGVB, which deserves further investigation. 展开更多
关键词 Hepatocellular carcinoma Portal vein tumor thrombus Transjugular intrahepatic portosystemic shunts Acute esophagogastric variceal bleeding Standard treatment Endoscopic treatment
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Prognosis after splenectomy plus pericardial devascularization vs transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding 被引量:1
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作者 Wei-Li Qi Jun Wen +5 位作者 Tian-Fu Wen Wei Peng Xiao-Yun Zhang Jun-Yi Shen Xiao Li Chuan Li 《World Journal of Gastrointestinal Surgery》 SCIE 2023年第8期1641-1651,共11页
BACKGROUND Portal hypertension combined with esophagogastric variceal bleeding(EGVB)is a serious complication in patients with hepatitis B virus(HBV)-related cirrhosis in China.Splenectomy plus pericardial devasculari... BACKGROUND Portal hypertension combined with esophagogastric variceal bleeding(EGVB)is a serious complication in patients with hepatitis B virus(HBV)-related cirrhosis in China.Splenectomy plus pericardial devascularization(SPD)and transjugular intrahepatic portosystemic shunt(TIPS)are effective treatments for EGVB.However,a comparison of the effectiveness and safety of those methods is lacking.AIM To compare the prognosis after SPD vs TIPS for acute EGVB after failure of endoscopic therapy or secondary prophylaxis of variceal rebleeding(VRB)in patients with HBV-related cirrhosis combined with portal hypertension.METHODS This retrospective cohort study included 318 patients with HBV-related cirrhosis and EGVB who underwent SPD or TIPS at West China Hospital of Sichuan University during 2009-2013.Propensity score-matched analysis(PSM),the Kaplan-Meier method,and multivariate Cox regression analysis were used to compare overall survival,VRB rate,liver function abnormality rate,and hepatocellular carcinoma(HCC)incidence between the two patient groups.RESULTS The median age was 45.0 years(n=318;226(71.1%)males).During a median follow-up duration of 43.0 mo,18(11.1%)and 33(21.2%)patients died in the SPD and TIPS groups,respectively.After PSM,SPD was significantly associated with better overall survival(OS)(P=0.01),lower rates of abnormal liver function(P<0.001),and a lower incidence of HCC(P=0.02)than TIPS.The VRB rate did not differ significantly between the two groups(P=0.09).CONCLUSION Compared with TIPS,SPD is associated with higher postoperative OS rates,lower rates of abnormal liver function and HCC,and better quality of survival as acute EGVB treatment after failed endoscopic therapy or as secondary prophylaxis of VRB in patients with HBV-related cirrhosis combined with portal hypertension.There is no significant between-group difference in VRB rates. 展开更多
关键词 Portal hypertension Liver cirrhosis esophagogastric variceal bleeding SPLENECTOMY Pericardial devascularization Transjugular intrahepatic portosystemic shunt
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Efficacy of transjugular intrahepatic portosystemic shunts in treating cirrhotic esophageal-gastric variceal bleeding 被引量:1
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作者 Xiao-Gang Hu Jian-Ji Dai +5 位作者 Jun Lu Gang Li Jia-Min Wang Yi Deng Rui Feng Kai-Ping Lu 《World Journal of Gastrointestinal Surgery》 SCIE 2024年第2期471-480,共10页
BACKGROUND Esophageal-gastric variceal bleeding(EGVB)represents a severe complication among patients with cirrhosis and often culminates in fatal outcomes.Interven-tional therapy,a rapidly developing treatment modalit... BACKGROUND Esophageal-gastric variceal bleeding(EGVB)represents a severe complication among patients with cirrhosis and often culminates in fatal outcomes.Interven-tional therapy,a rapidly developing treatment modality over the past few years,has found widespread application in clinical practice due to its minimally inva-sive characteristics.However,whether transjugular intrahepatic portosystemic shunt(TIPS)treatment has an impact on patient prognosis remains controversial.METHODS A retrospective study was conducted on ninety-two patients presenting with cirrhotic EGVB who were admitted to our hospital between September 2020 and September 2022.Based on the different modes of treatment,the patients were assigned to the study group(TIPS received,n=50)or the control group(per-cutaneous transhepatic varices embolization received,n=42).Comparative ana-lyses were performed between the two groups preoperatively and one month postoperatively for the following parameters:Varicosity status;hemodynamic parameters[portal vein flow velocity(PVV)and portal vein diameter(PVD);platelet count(PLT);red blood cell count;white blood cell count(WBC);and hepatic function[albumin(ALB),total bilirubin(TBIL),and aspartate transaminase(AST)].The Generic Quality of Life Inventory-74 was utilized to assess quality of life in the two groups,and the 1-year postoperative rebleeding and survival rates were compared.RESULTS Following surgical intervention,there was an improvement in the incidence of varicosity compared to the preoperative status in both cohorts.Notably,the study group exhibited more pronounced enhancements than did the control group(P<0.05).PVV increased,and PVD decreased compared to the preoperative values,with the study cohort achieving better outcomes(P<0.05).PLT and WBC counts were elevated postoperatively in the two groups,with the study cohort displaying higher PLT and WBC counts(P<0.05).No differences were detected between the two groups in terms of serum ALB,TBIL,or AST levels either preoperatively or postoperatively(P<0.05).Postoperative scores across all dimensions of life quality surpassed preoperative scores,with the study cohort achieving higher scores(P<0.05).At 22.00%,the one-year postoperative rebleeding rate in the study cohort was significantly lower than that in the control group(42.86%;P<0.05);conversely,no marked difference was obser-ved in the 1-year postoperative survival rate between the two cohorts(P>0.05).CONCLUSION TIPS,which has demonstrated robust efficacy in managing cirrhotic EGVB,remarkably alleviates varicosity and improves hemodynamics in patients.This intervention not only results in a safer profile but also contributes significantly to a more favorable prognosis. 展开更多
关键词 Liver cirrhosis esophagogastric variceal bleeding Transjugular intrahepatic portosystemic shunt PROGNOSIS
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Risk factors for esophagogastric variceal-related poor outcomes in primary biliary cholangitis:A prospective cohort study
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作者 Lin Han Huan Xie +7 位作者 Xue-Mei Ma Xiao-Long Lu Jun Zhao Qing-Sheng Liang Zheng-Sheng Zou Jing-Feng Bi Bo Jin Ying Sun 《iLIVER》 2024年第1期30-37,共8页
Background and aims:Esophagogastric varices(EGV)are common complications of primary biliary cholangitis(PBC).We examined the risk factors for variceal bleeding-related liver transplantation(LT)or death.Methods:This pr... Background and aims:Esophagogastric varices(EGV)are common complications of primary biliary cholangitis(PBC).We examined the risk factors for variceal bleeding-related liver transplantation(LT)or death.Methods:This prospective observational cohort study involved PBC in our hospital from 1 January 2005 to 1 January 2020.The clinical endpoints were variceal bleeding-related LT and death.Survival analysis was performed using the Kaplan-Meier estimate,cox regression analysis was performed to investigate risk factors.Results:PBC with EGV had significantly shorter survival than those without(p?0.002).Endoscopic prophylaxis significantly improved poor outcomes in PBC with EGV(p<0.001).Risk factors in patients with EGV included:cholinesterase(CHE)of<1.0upper limit of normal(ULN),international normalized ratio(INR)of>1.2ULN at baseline,total bilirubin of>1.2ULN,aspartate aminotransferase(AST)of>2.3ULN after 1 year of ursodeoxycholic acid(UDCA)treatment,non-biochemical responders according to the Paris criteria,and no history of endoscopic therapy.In PBC without EGV,risk factors included AST of>2.3ULN,INR of>1.2ULN at baseline,CHE of<1.0ULN after 1 year of UDCA treatment,and GLOBE score of>1.125.Conclusion:This study provides evidence that AST,INR and CHE are major risk factors for variceal bleedingrelated poor outcomes in PBC.For PBC with EGV,a good biochemical response to UDCA and endoscopic prophylaxis may improve survival.These findings can aid for guiding initial PBC risk stratification and screening endoscopy in patients without EGV. 展开更多
关键词 Primary biliary cholangitis esophagogastric varices Ursodeoxycholic acid Liver transplant-free survival Endoscopic therapy Risk factors
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Surgical treatment of hepatocellular carcinoma with severe intratumoral arterioportal shunt 被引量:11
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作者 Hiromichi Ishii Teruhisa Sonoyama +12 位作者 Shingo Nakashima Hiroyuki Nagata Atsushi Shiozaki Yoshiaki Kuriu Hisashi Ikoma Masayoshi Nakanishi Daisuke Ichikawa Hitoshi Fujiwara Kazuma Okamoto Toshiya Ochiai Yukihito Kokuba Chohei Sakakura Eigo Otsuji 《World Journal of Gastroenterology》 SCIE CAS CSCD 2010年第25期3211-3214,共4页
We report a case of hepatocellular carcinoma (HCC) that caused a severe arterioportal shunt (APS). A 49-year-old man was admitted to hospital due to esophagogastric variceal hemorrhage and HCC, and underwent endoscopi... We report a case of hepatocellular carcinoma (HCC) that caused a severe arterioportal shunt (APS). A 49-year-old man was admitted to hospital due to esophagogastric variceal hemorrhage and HCC, and underwent endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS). He was then referred to our hospital. Abdominal computed tomography revealed a lowdensity lesion in the posterior segment of the liver and an intratumoral APS, which caused portal hypertension. Although the patient underwent EVL, EIS, Hassab’s operation, and transcatheter arterial embolization for APS, he vomited blood due to rupture of esophagogastric varices. Right hepatectomy was performed for the treatment of HCC and APS, although the indocyanine green retention value at 15 min after intravenous injection was poor (30%). The patient’s postoperative course was uneventful. Eventually, APS disappeared and the esophagogastric varices improved. 展开更多
关键词 Arterioportal shunt Hepatocellular carcinoma esophagogastric varices
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A creatinine-based model for predicting recurrent bleeding after modified percutaneous transhepatic variceal embolization in patients with cirrhosis 被引量:3
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作者 Kun Ji Xin Li +11 位作者 Hanlong Zhu Si Zhao Pengchao Zhan Yang Shi Shuwen Ye Bingcan Xie Yuyuan Zhang Peng Yu Zhigang Ren Juan Ding Xinwei Han Zhen Li 《Journal of Interventional Medicine》 2022年第2期95-102,共8页
Background:Patients who survive initial esophagogastric variceal bleeding(EVB)are at an increased risk of recurrent bleeding and death;however,a reliable predictive model is lacking.We aimed to develop a model for reb... Background:Patients who survive initial esophagogastric variceal bleeding(EVB)are at an increased risk of recurrent bleeding and death;however,a reliable predictive model is lacking.We aimed to develop a model for rebleeding prediction in patients with EVB after modified percutaneous transhepatic variceal embolization(PTVE)with cyanoacrylate.Methods:A total of 122 patients with EVB who underwent PTVE from January 2015 to November 2020 were enrolled.Multivariate logistic analyses were conducted to determine independent risk factors for nomogram construction.The discrimination,calibration,and clinical utility of the nomogram were compared with the Model for End-stage Liver Disease score(MELD)and the Child–Pugh model.Risk stratification was performed according to the nomogram.Results:Rebleeding within 3 months of PTVE occurred in 32 patients(26.2%).Independent rebleeding indicators included prior history of endoscopic therapy,Child–Pugh score,partial splenic embolization,and creatinine level.The nomogram incorporating these four predictors achieved excellent calibration and discriminatory abilities,with a concordance index of 0.85,which was confirmed to be 0.83 through bootstrapping validation.The nomogram demonstrated superior discrimination and clinical applicability than the MELD and Child–Pugh models.As shown in the Kaplan–Meier curves,high-risk patients had a high probability of rebleeding(P<0.001).Conclusions:The creatinine-based nomogram had a superior ability to predict rebleeding after PTVE in patients with EVB.Risk stratification may help identify high-risk patients and lead to the earlier implementation of aggressive treatments and formulation of intensive follow-up plans. 展开更多
关键词 esophagogastric varices Percutaneous transhepatic variceal embolization Nomogram Prediction
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Guidelines for the Management of Esophagogastric Variceal Bleeding in Cirrhotic Portal Hypertension
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作者 Xiaoyuan Xu Chengwei Tang +4 位作者 Enqiang Linghu Huiguo Ding Chinese Society of Hepatology,Chinese Medical Association Chinese Society of Gastroenterology,Chinese Medical Association Chinese Society of Digestive Endoscopy,Chinese Medical Association 《Journal of Clinical and Translational Hepatology》 SCIE 2023年第7期1565-1579,共15页
To standardize the diagnosis,treatment,and management of esophagogastric variceal bleeding(EVB)in patients with cirrhotic portal hypertension,the Chinese Society of Hepatology,the Chinese Society of Gastroenterology,a... To standardize the diagnosis,treatment,and management of esophagogastric variceal bleeding(EVB)in patients with cirrhotic portal hypertension,the Chinese Society of Hepatology,the Chinese Society of Gastroenterology,and the Chinese Society of Digestive Endoscopy of the Chinese Medical Association brought together relevant experts,reviewed the latest national and international progress in clinical research on EVB in cirrhotic portal hypertension,and followed evidencebased medicine to update the Guidelines on the Management of EVB in Cirrhotic Portal Hypertension.The guidelines provide recommendations for the diagnosis,treatment,and management of EVB in cirrhotic portal hypertension and with the aim to improve the level of clinical treatment of EVB in patients with cirrhotic portal hypertension. 展开更多
关键词 GUIDELINE MANAGEMENT esophagogastric variceal bleeding CIRRHOSIS Portal hypertension
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Embolization combined with endoscopic variceal ligation for the treatment of esophagogastric variceal bleeding in patients with cirrhosis 被引量:10
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作者 HUANG Liu-ye CUI Jun WU Cheng-rong LIU Yun-xiang 《Chinese Medical Journal》 SCIE CAS CSCD 2007年第1期36-40,共5页
Background Esophagogastric variceal bleeding caused by cirrhosis is a kind of emergent condition in the clinic. This study was conducted to explore the therapeutic effect and superiority of embolization of gastric fun... Background Esophagogastric variceal bleeding caused by cirrhosis is a kind of emergent condition in the clinic. This study was conducted to explore the therapeutic effect and superiority of embolization of gastric fundus vadces combined with endoscopic variceal ligation (EVL) of esophageal varices for the treatment of patients with esophagogastric variceal bleeding caused by cirrhosis. Methods Totally 172 patients were diagnosed by endoscopic examination within 24 hours of hospitalization with active gastric fundus variceal bleeding and grade II above esophageal varices caused by cirrhosis. Other causes leading to upper digestive tract bleeding were excluded. Patients were randomly divided into a control group (n=82) and a therapy group (n=-90) following a random number table method. For the former, embolization for gastric fundus varices was performed, then an EVL for esophageal varices was performed 2 months later. For the therapy group, embolization for gastric fundus varices and EVL for esophageal varices were performed at the same time. Results The rate of emergency hemostasis in the therapy group was 100.0%, higher than that in the control group (87.8%, P〈0.05). The rate of early rebleeding in the therapy group was 6.7% while the rate in the control group was 23.6% (P〈0.05). No complications related to treatment occurred in both groups. Conclusion Embolization for gastric fundus varices combined with EVL for esophageal varices is a safe and effective method for the treatment of patients with esophagogastric variceal bleeding caused by cirrhosis. 展开更多
关键词 esophagogastric varices EMBOLIZATION endoscopic variceal ligation CIRRHOSIS
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