食管静脉曲张再发出血的防治进展

食管静脉曲张出血的患者在急诊出血得到控制后仍有很高的再发出血率,其病死率高,因此必须预防再发出血。目前有多种方法预防再发出血,迄今为止,并没有一个标准化方案,各种方法联合应用更可取。单独应用非选择性β受体阻滞剂或与硝酸酯类和内镜治疗联合应用临床疗效可靠,尤其是非选择性β受体阻滞剂与内镜介入治疗联合应用疗效更佳。药物与内镜介入疗法失败后,经颈静脉肝内门脉系统分流低病死率,经颈静脉肝内门脉系统分流术逐渐取代常规分流术。随着肝移植技术的发展,肝移植作为食管静脉曲张再发出血的治疗方法应被提上日程。

Preventive and Therapeutic Progress of Rebleeding of Esophageal Varices

Patients with esophageal varices still have high incidence of rebleeding and high case fatality after the the first bleeding had been controlled in emergency department,so it is necessary to prevent its rebleeding.At present, although there are many methods to prevent its rebleeding , there is no one standardized method up to now and combined therapy of many therapeutic method is more feasible . Applying nonselective beta-receptor inhibitor alone or combined with nitrate and therapeutic endoscopy can achieve reliable clinical efficacy,especially the combination of nonselective beta-receptor inhibitor and therapeutic endoscopy is more better.Once it is failed,transjugular intrahepatic portosystemic stent shunt can lower motality as a rescue therapy,and is gradualy replacing by-pass technique.With the development of liver transplantation.it is being put into consideration as a therapeutic method for esophageal varices rebleeding .