肝硬化门静脉高压症合并食管胃底静脉曲张破裂出血的急救处理

目的：探讨肝硬化门静脉高压症合并食管胃底静脉曲张破裂出血急诊抢救治疗的临床经验并评估其疗效。方法回顾性分析2005年1月至2012年12月浙江省湖州市南浔区人民医院收治的11例肝硬化门静脉高压症合并食管胃底静脉曲张破裂出血患者的临床资料。结果11例患者上消化道出血24 h内止血比例为9／11，全部11例患者上消化道出血72 h内出血停止。但其中1例患者于治疗后第7天再出血，因拒绝再次三腔二囊管止血而死亡；1例患者上消化道出血后13 d死于肝功能衰竭。治疗总有效率为82％（9／11），死亡率为18％（2／11）。结论采取内科措施控制出血，将紧急手术转为择期手术，可提高肝硬化门静脉高压症合并食管胃底静脉曲张破裂出血急诊抢救治疗的成功率。

Emergency treatment of esophageal and gastric varices bleeding in patients with cirrhosis and portal hypertension

Objective To evaluate the effect of the practice on emergency treatment for esophageal and gastric varices bleeding in patients with cirrhosis and portal hypertension.Methods The clinical data of 1 1 patients with cirrhosis and portal hypertension combined with esophageal and gastric varices bleeding which were treated conservatively between January 2005 and December 2012 in Nanxun District People′s Hospital of Huzhou were retrospectively analyzed.Results The bleeding was controlled within 24 hours for 9 of the 1 1 cases and within 72 hours for the other 2 cases.Rebleeding was found in 1 case on the seventh day who died because of rejecting Sengstaken-Blackmore tube hemostasis.One patient died from hepatic failure on the thirteenth day.The total effective rate was 82%（9/11）,and the death rate was 18%（2/11）.Conclusions The control of the bleeding by conservative methods makes it possible for thepatients to receive an elective operation instead of an emergency operation.As a result,the success rate of the treatment for such cases may increase.