Franco D, Deporte A, Darragon T, Bismuth H
Nouv Presse Med. 1975 Dec 6;4(42):2993-6.
The cause of upper gastrointestinal bleeding was studied in 85 cirrhotic patients by emergency endoscopy. In every patient, one or several lesions were observed and the site of bleeding was ascertained in 59. The two main causes were oesophago-gastric varices (46 p.cent) and acute mucosal lesions(42 p.cent). The source of bleeding appeared to be related to the degree of liver function impairment. In patients with no or moderate liver function impariment, bleeding usually originated from varices or from drug-associated mucosal erosions. Patients with severe impairment of liver function most often bled from spontaneous acute oeso-gastro-duodenal ulcerations. These ulcerations resembled what has been described in "stress" hemorrhage. Because of the relationship between liver function and the cause of hemorrhage, mortality was lower in variceal bleeders (29 p.cent) than in patients with spontaneous ulcerations (83 p.cent). In patients with severely impaired liver function, portacaval shunt was rarely indicated since hemorrhage was generally due to acute mucosal ulcerations.
通过急诊内镜检查对85例肝硬化患者上消化道出血的病因进行了研究。在每例患者中，均观察到一个或多个病变，59例患者确定了出血部位。两个主要病因是食管胃静脉曲张（46%）和急性黏膜病变（42%）。出血来源似乎与肝功能损害程度有关。在无肝功能损害或轻度肝功能损害的患者中，出血通常源于静脉曲张或药物相关的黏膜糜烂。肝功能严重损害的患者大多因自发性急性食管胃十二指肠溃疡出血。这些溃疡类似于“应激”性出血中所描述的情况。由于肝功能与出血原因之间的关系，静脉曲张出血患者的死亡率（29%）低于自发性溃疡患者（83%）。在肝功能严重受损的患者中，很少进行门腔分流术，因为出血通常是由急性黏膜溃疡引起的。
