Sauerbruch T
Medizinische Klinik II, Klinikum Grosshadern der Universität München.
Leber Magen Darm. 1990 Jan;20(1):11-2, 15-9.
Portal hypertension may be caused by portal venous outflow obstruction, an increased portal venous inflow due to a hyperdynamic circulation or both. Portal venous collaterals usually develop above a threshold portal venous pressure of 10 to 12 mm Hg. Only about one third of patients with esophageal varices eventually bleed. However, the mortality in patients who do bleed is high (around 50%) mostly because patients frequently die prior to hospital admission. Immediate endoscopy for precise location of site of bleeding is essential. Bleeding then may be controlled by drugs which lower portal pressure, balloon-tube tamponade or emergency injection sclerotherapy. Of these therapeutic options sclerotherapy probably has the highest success rate for the acute control of variceal bleeding. It can in addition be combined with the initial endoscopic diagnostic procedure, and repeated injection sclerotherapy can reduce the incidence of recurrent variceal bleeding. Portasystemic shunts, transection and devascularisation operations are nowadays only used in patients in whom repeated sclerotherapy had failed. Beta-blocking agents may be an alternative for long-term management after variceal bleeding, although the results are controversial. The data regarding prophylaxis of first variceal hemorrhage are conflicting. Prophylactic regimens should only be carried out in the form of controlled trials.
门静脉高压可能由门静脉流出道梗阻、高动力循环导致的门静脉流入增加或两者共同引起。门静脉侧支循环通常在门静脉压力阈值达到10至12毫米汞柱以上时形成。只有约三分之一的食管静脉曲张患者最终会出血。然而，出血患者的死亡率很高（约50%），主要是因为患者常在入院前死亡。立即进行内镜检查以精确确定出血部位至关重要。然后可通过降低门静脉压力的药物、气囊导管压迫或紧急注射硬化疗法来控制出血。在这些治疗选择中，硬化疗法可能对急性控制静脉曲张出血的成功率最高。它还可与初始内镜诊断程序相结合，重复注射硬化疗法可降低静脉曲张再出血的发生率。门体分流术、横断术和去血管化手术如今仅用于反复硬化疗法失败的患者。β受体阻滞剂可能是静脉曲张出血后长期管理的一种替代方法，尽管结果存在争议。关于预防首次静脉曲张出血的数据相互矛盾。预防性治疗方案应仅以对照试验的形式进行。
