National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2013 Oct;76(10):539-46. doi: 10.1016/j.jcma.2013.06.011. Epub 2013 Jul 20.
Gastroesophageal varices bleeding is a major complication in patients with cirrhosis. Gastric varices (GVs) occur in approximately 20% of patients with portal hypertension. However, GV bleeding develops in only 25% of patients with GV and requires more transfusion and has higher mortality than esophageal variceal (EV) bleeding. The best strategy for managing acute GV bleeding is similar to that of acute EV bleeding, which involves airway protection, hemodynamic stabilization, and intensive care. Blood transfusion should be cautiously administered in order to avoid rebleeding. Vasoactive agents such as terlipressin or somatostatin should be used when GV bleeding is suspected. Routine use of prophylactic antibiotics reduces bacterial infection and lowers rebleeding rates. By administering endoscopic cyanoacrylate injection, the initial hemostasis rate achieved is at least 90% in most cases; the average mortality rate of GV bleeding is approximately 10-30% and the rebleeding rate is between 22% and 37%. Although endoscopic injection of cyanoacrylate is superior to sclerotherapy and band ligation, and has remained the treatment of choice for treating acute GV bleeding, the outcome of this treatment is still unsatisfactory. New treatment options, such as thrombin injection, transjugular intrahepatic portosystemic shunts, or balloon-occluded retrograde transvenous obliteration, have shown promising results for acute GV bleeding. However, randomized controlled trials are needed to compare the efficacy of these therapies with cyanoacrylate.
胃食管静脉曲张出血是肝硬化患者的主要并发症。约 20%的门静脉高压患者会出现胃静脉曲张（GV）。然而，仅有 25%的 GV 患者会发生 GV 出血，且需要更多的输血，死亡率高于食管静脉曲张（EV）出血。管理急性 GV 出血的最佳策略与急性 EV 出血相似，包括气道保护、血流动力学稳定和重症监护。为避免再次出血，应谨慎输血。当怀疑 GV 出血时，应使用血管活性药物如特利加压素或生长抑素。预防性使用抗生素可减少细菌感染并降低再出血率。在大多数情况下，内镜氰基丙烯酸酯注射可实现至少 90%的初始止血率；GV 出血的平均死亡率约为 10-30%，再出血率在 22%-37%之间。尽管内镜注射氰基丙烯酸酯优于硬化治疗和套扎治疗，并且仍然是治疗急性 GV 出血的首选治疗方法，但这种治疗方法的效果仍不尽如人意。新的治疗选择，如凝血酶注射、经颈静脉肝内门体分流术或球囊阻塞逆行静脉闭塞术，已显示出对急性 GV 出血的有希望的结果。然而，需要进行随机对照试验来比较这些疗法与氰基丙烯酸酯的疗效。
