Tripathi Dhiraj, Jalan Rajiv
Department of Hepatology, Royal Infirmary of Edinburgh, Edinburgh, UK.
Eur J Gastroenterol Hepatol. 2006 Nov;18(11):1155-60. doi: 10.1097/01.meg.0000236875.52730.b8.
Uncertainty exists about the ideal therapy for gastric and ectopic varices owing to relatively few controlled studies. Endoscopic therapy with tissue adhesives and thrombin appear promising. Transjugular intrahepatic portosystemic stent-shunt has a role in patients with refractory gastric variceal bleeding in the presence of a patent portal vein. The addition of coil embolization may be particularly useful for ectopic varices, as these can continue to bleed despite successful portal pressure reduction. The high efficacy of transjugular intrahepatic portosystemic stent-shunt has to be balanced against the potential for increased encephalopathy. Balloon occluded retrograde transvenous obliteration is a recent technique for patients with gastro-renal shunts and large gastric varices. Early results are promising, and balloon occluded retrograde transvenous obliteration may be valuable in patients who bleed at lower portal pressures, in the encephalopathic patient, or where the portal vein is not patent. Its use may be limited by availability or lack of technical expertise, and caution is required in patients with large oesophageal varices.
由于对照研究相对较少，关于胃静脉曲张和异位静脉曲张的理想治疗方法仍存在不确定性。使用组织粘合剂和凝血酶的内镜治疗似乎很有前景。经颈静脉肝内门体分流术在门静脉通畅的难治性胃静脉曲张出血患者中具有一定作用。对于异位静脉曲张，添加弹簧圈栓塞可能特别有用，因为尽管门静脉压力成功降低，这些静脉曲张仍可能继续出血。经颈静脉肝内门体分流术的高效性必须与肝性脑病增加的可能性相权衡。球囊闭塞逆行静脉栓塞术是一种针对脾肾分流和大胃静脉曲张患者的新技术。早期结果很有前景，球囊闭塞逆行静脉栓塞术对于门静脉压力较低时出血的患者、肝性脑病患者或门静脉不通畅的患者可能很有价值。其应用可能受到可用性或技术专业知识缺乏的限制，对于有大食管静脉曲张的患者需要谨慎使用。
