Matloff D S
Tufts University School of Medicine, Boston, Massachusetts.
Gastroenterol Clin North Am. 1992 Mar;21(1):103-18.
Once the bleeding patient has been resuscitated and the diagnosis of acute variceal hemorrhage established by endoscopy, emergency injection sclerotherapy should be employed as the therapeutic option of choice. Endoscopic band ligation is a promising new technique that may prove to be as effective as sclerotherapy, with fewer complications. Pharmacologic treatment (with vasopressin and nitroglycerin) and balloon tamponade remain important alternative treatments, both as empiric temporizing therapy before sclerotherapy can be arranged and in the approximately 30% of patients who continue to bleed after a single sclerotherapy session. Continued bleeding in many of these patients can be controlled with a second session of sclerotherapy. If active acute bleeding persists after two sclerotherapy treatments, treatment should be considered a failure. Some of these patients may be suitable for surgical treatment with either staple-gun transection of the esophagus or emergency portacaval shunting.
一旦出血患者得到复苏，且通过内镜检查确诊为急性静脉曲张出血，应采用紧急注射硬化疗法作为首选治疗方法。内镜下套扎术是一种有前景的新技术，可能证明与硬化疗法同样有效，且并发症更少。药物治疗（使用血管加压素和硝酸甘油）和气囊压迫仍然是重要的替代治疗方法，既作为在安排硬化疗法之前的经验性临时治疗，也用于约30%在单次硬化疗法后仍继续出血的患者。这些患者中的许多人通过第二次硬化疗法可以控制持续出血。如果经过两次硬化疗法后仍有活动性急性出血，则应认为治疗失败。其中一些患者可能适合进行手术治疗，可选择用吻合器横断食管或紧急门腔分流术。
