Ferguson James W, Hayes Peter C
Department of Hepatology, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
Eur J Gastroenterol Hepatol. 2006 Nov;18(11):1167-71. doi: 10.1097/01.meg.0000236873.67977.98.
Variceal bleeding is a common complication of cirrhosis and has a high in-patient mortality (30-50%). Rebleeding is a major cause of death and occurs in 35% of patients at 6 weeks after the initial bleeding episode and 75% at 1 year. Therefore, strategies that improve survival by preventing rebleeding in the early period are crucial to improve long-term survival. This review concentrates on the evidence for transjugular intrahepatic portosystemic shunt in the prevention of rebleeding. Transjugular intrahepatic portosystemic shunt in comparison with endoscopic and pharmacological therapies is clearly superior at reducing the rate of rebleeding in those patients who had an oesophageal variceal haemorrhage. It, however, does not improve mortality and is associated with a greater risk of encephalopathy and is more costly than endoscopic procedures. It is therefore generally used when endoscopic therapy has failed but may be useful in patients who would tolerate a rebleed poorly such as Child's C patients. Randomized-controlled trials are required to evaluate the role of polytetrafluoroethylene shunts in the prevention of rebleeding as their improved patency and suggested reduced incidence of encephalopathy make them a very attractive potential treatment for rebleeding.
静脉曲张破裂出血是肝硬化的常见并发症，住院死亡率很高（30%-50%）。再出血是主要死因，初次出血发作后6周内35%的患者会发生再出血，1年内这一比例为75%。因此，通过在早期预防再出血来提高生存率的策略对于改善长期生存至关重要。本综述着重探讨经颈静脉肝内门体分流术预防再出血的证据。与内镜和药物治疗相比，经颈静脉肝内门体分流术在降低食管静脉曲张出血患者的再出血率方面明显更具优势。然而，它并不能提高生存率，且与发生肝性脑病的风险增加有关，费用也比内镜手术更高。因此，它通常在内镜治疗失败时使用，但对于诸如Child's C级患者这类难以耐受再出血的患者可能有用。需要进行随机对照试验来评估聚四氟乙烯分流术在预防再出血中的作用，因为其通畅性改善且肝性脑病发生率降低，使其成为一种非常有吸引力的再出血潜在治疗方法。
