Department of Medical Education, Digestive Center, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2010 Feb;26(2):55-67. doi: 10.1016/s1607-551x(10)70009-7.
Acute esophageal variceal hemorrhage (AEVH) is a severe complication of portal hypertension. Its management has rapidly evolved in recent years. Traditional methods included vasoconstrictor and balloon tamponade. Vasoconstrictors were shown to control approximately 80% of the bleeding episodes and are generally used as a first-line therapy. Following the use of vasoconstrictors, endoscopic therapy is often used to arrest the bleeding varices and prevent early rebleeding. A meta-analysis showed that the combination of vasoconstrictor and endoscopic therapy is superior to endoscopic therapy alone for controlling AEVH. Balloon tamponade may be used to achieve temporary control of the hemorrhage in case of severe bleeding. A transjugular intrahepatic portosystemic stent shunt may be needed in patients with refractory acute variceal hemorrhage. Surgical intervention is now widely contraindicated during acute variceal hemorrhage, except for patients with good liver reserve. Conversely, apart from the control of acute variceal hemorrhage, prophylactic antibiotics were shown to be helpful in the prevention of bacterial infection and to prevent early variceal rebleeding. With the introduction of new treatment modalities and the measures taken to manage patients with AEVH, the mortality due to AEVH has significantly decreased in recent years.
急性食管胃静脉曲张出血（AEVH）是门静脉高压的严重并发症。近年来，其治疗方法迅速发展。传统方法包括血管收缩剂和气囊填塞。血管收缩剂可控制约 80%的出血发作，通常用作一线治疗。在使用血管收缩剂后，通常使用内镜治疗来止血和预防早期再出血。一项荟萃分析表明，血管收缩剂联合内镜治疗在控制 AEVH 方面优于单独内镜治疗。在严重出血的情况下，气囊填塞可用于暂时控制出血。对于难治性急性静脉曲张出血的患者，可能需要经颈静脉肝内门体分流术。急性静脉曲张出血时，手术干预现在被广泛禁忌，除非患者的肝脏储备良好。相反，除了控制急性静脉曲张出血外，预防性使用抗生素有助于预防细菌感染和早期静脉曲张再出血。随着新的治疗方法的引入和对 AEVH 患者的管理措施的采取，近年来，AEVH 的死亡率显著下降。
