Müting D, Kalk J F, Fischer R, Wiewel D
Heinz Kalk-Krankenhaus, Am Gradierbau, Bad Kissingen, Federal Republic of Germany.
J Hepatol. 1990 Mar;10(2):158-62. doi: 10.1016/0168-8278(90)90045-s.
Spontaneous regression of oesophageal varices in liver cirrhotics without sclerotherapy or shunt operation has only been known in alcoholic cirrhosis after alcohol abstinence. Therefore, 20 liver cirrhotics of different aetiologies were controlled over 13 years (six alcohol, nine hepatitis, five haemochromatosis). Under strict alcohol abstinence, all underwent treatment with lactulose and ammonia-reducing amino acids to improve the urea synthesis in the liver. Since gastrointestinal bleeding was not observed, neither sclerotherapy nor shunt operation were performed. Initially, all patients had oesophageal varices (nine stage III, three stage II-III, eight stage II). Following conservative therapy, eight cirrhotics showed total regression and twelve showed stage I-II. Their Child-Pugh index, and urea synthesis rate improved significantly. Possible causes for the spontaneous regression of oesophageal varices are strict abstinence from alcohol, spontaneous seroconversion in six posthepatic B-cirrhoses and consequent phlebotomy in haemochromatosis.
肝硬化患者未经硬化治疗或分流手术而出现食管静脉曲张自发消退的情况仅在戒酒的酒精性肝硬化患者中被知晓。因此，对20例不同病因的肝硬化患者进行了13年的观察（6例酒精性、9例肝炎后、5例血色素沉着症）。在严格戒酒的情况下，所有患者均接受乳果糖和降氨氨基酸治疗以改善肝脏尿素合成。由于未观察到胃肠道出血，因此未进行硬化治疗或分流手术。最初，所有患者均有食管静脉曲张（9例为Ⅲ期，3例为Ⅱ - Ⅲ期，8例为Ⅱ期）。经过保守治疗后，8例肝硬化患者食管静脉曲张完全消退，12例患者表现为Ⅰ - Ⅱ期。他们的Child - Pugh指数和尿素合成率显著改善。食管静脉曲张自发消退的可能原因包括严格戒酒、6例肝后性B型肝硬化患者的自发血清学转换以及血色素沉着症患者随后进行的放血治疗。
