Sherlock S
Department of Surgery, Royal Free Hospital School of Medicine, University of London, England.
Am J Surg. 1990 Jul;160(1):9-13. doi: 10.1016/s0002-9610(05)80861-x.
Bleeding from esophageal varices is related to the size and pressure of varices, endoscopic danger signs, and severity of liver failure. Prevention of bleeding with propranolol has given conflicting results in controlled trials, but is a safe treatment. Prophylactic sclerotherapy has been shown to reduce bleeding in European studies, but this has not been confirmed by studies in the United States. Acute variceal bleeding can usually be controlled by sclerotherapy, which may be supplemented by pharmacotherapy with vasopressin, nitroglycerin, or somatostatin. Recurrent bleeding is prevented initially by sclerotherapy, with surgery reserved for patients who have not responded to this treatment. Once bleeding has been controlled, the suitability and timing of hepatic transplantation must be considered.
食管静脉曲张出血与静脉曲张的大小和压力、内镜危险征象以及肝衰竭的严重程度有关。在对照试验中，使用普萘洛尔预防出血的结果存在矛盾，但它是一种安全的治疗方法。在欧洲的研究中，预防性硬化疗法已被证明可减少出血，但美国的研究尚未证实这一点。急性静脉曲张出血通常可用硬化疗法控制，也可辅以血管加压素、硝酸甘油或生长抑素进行药物治疗。复发性出血最初通过硬化疗法预防，手术仅适用于对此治疗无反应的患者。一旦出血得到控制，就必须考虑肝移植的适用性和时机。
