肝炎肝硬变并发上消化道出血治疗分析

目的:讨论肝炎肝硬变并发上消化道出血多种治疗方法的疗效。方法:48例肝炎肝硬变并发上消化道出血患者均先行内科保守治疗,采用垂体后叶素加西咪替丁或洛赛克。无效者采用食道胃底曲张静脉硬化剂治疗(EIS)或套扎治疗(EVL),或经颈静脉途径肝内门体分流术(TIPS)。结果:48例中采取内科保守治疗有效27例(56.3％)。无效21例(43.7％)中,3例行TIPS,止血有效,但2例于半年内死于肝性脑病,1例发生分流道阻塞;6例行EIS或EVL,止血有效;死亡12例,其中死于失血性休克4例,死于肝性脑病6例,死于肝肾综合症2例。结论:肝炎肝硬变并发上消化道出血,采取内科保守治疗,大多可取得良好疗效。无效者可采用EIS、EVL、TIPS能快速有效地控制出血,TIPS由于其术后肝性脑病及分流道再阻塞发生率高,中远期疗效不满意。

Treatment Analysis of Hepatitic Cirrhosis with Upper Gastrointestinal Hemorrhage

To analyse curative effect of different therapeutics on hepatitic cirrhosis with upper gastrointestinal hemorrhage . Methods: 48 patients of hepatitic cirrhosis with upper gastrointestinal hemorrhage were treated with internal medicine treatment first-vasopressin added losec or cimetidine, the ineffectual cases were treated with EIS,EVL or TIPS. Results: Of 48 patients treated with internal medicine treatment, 27 cases (56.3%) were well-done,21(43.7%) were infected,of which 4 cases died from hemor-rhagic shock, 6 cases from hepatic encephalopathy,2 cases from hepatorenal syndrome; 6 cases were treated with EIS or EVL for hemostasia; of 3 cases treated with TIPS for hemostasia, 2 cases died from hepatic encephalopathy within 6 months, 1 patient's shunt path was blocked. Conclusion: The internal medicine treatments are mostly efficient for hemostasia to patients of hepatitic cirrhosis with upper gastrointestinal hemorrhage, the inefficient cases can be treated with EIS, EVL or TIPS for hemostasia. Hepatic encephalopathy and shunt path block often occur after TIPS, so the curative effect of TIPS is not satisfying in metaphase and long term.