Fleig W E
First Department of Medicine, Martin-Luther-University Halle-Wittenberg, Saale, Germany.
Hepatogastroenterology. 1999 Mar-Apr;46(26):746-52.
Variceal bleeding is still one of the key therapeutic problems inpatients with portal hypertension. Vasoactive drugs for the treatment of acute hemmorrhage as well as for the prevention of first and recurrent bleeding have been shown to be effective, in some situations as effective as endoscopic sclerotherapy. In recent years, endoscopic band ligation has replaced sclerotherapy for the prevention of rebleeding and become the new nonsurgical standard in this situation. Furthermore, the transjugular, intrahepatic, portosystemic stent shunt (TIPS) has gained widespread acceptance as a salvage procedure for acute bleeders unresponsive to other treatments as well as the second line approach to failures of chronic endoscopic or drug therapy for prevention of rebleeding. Primary prophylaxis is still the domain of beta-blockers or/and long-acting nitrates.
静脉曲张出血仍然是门静脉高压症患者主要的治疗难题之一。用于治疗急性出血以及预防首次出血和再出血的血管活性药物已被证明是有效的，在某些情况下与内镜硬化治疗一样有效。近年来，内镜下套扎术已取代硬化治疗用于预防再出血，并成为这种情况下新的非手术标准。此外，经颈静脉肝内门体分流术（TIPS）作为对其他治疗无反应的急性出血患者的挽救性手术以及慢性内镜或药物治疗预防再出血失败后的二线治疗方法已被广泛接受。一级预防仍然是β受体阻滞剂或/和长效硝酸盐类药物的领域。
