Terblanche J
Department of Surgery, University of Cape Town, South Africa.
Surg Endosc. 1988;2(3):149-55. doi: 10.1007/BF02498789.
Although sclerotherapy is currently the most widely used treatment for the management of both acute variceal bleeding and the long-term management of patients with varices, its definitive role in the treatment of these patients has yet to be finally proven. Sclerotherapy appears to be the most effective treatment for the majority of patients with acute variceal bleeding. Failures require either a shunt or a transection and/or devascularisation procedure. Current evidence favours simple staple gun transection or a shunt (either a portacaval shunt or a side-to-side narrow diameter polytetrafluoroethylene graft between the portal vein and vena cava). In long-term management of patients after a variceal bleed the currently favoured treatment is repeated sclerotherapy. However, failures should be identified early. We define failures as patients who present with varices that are either difficult to eradicate by sclerotherapy or who have repeated life-threatening variceal bleeds during the course of repeated injection sclerotherapy. Such patients should have either a portal-to-systemic shunt or a transection and devascularisation operation. Further controlled trials are required to define the specific indications for the individual forms of therapy. Prophylactic treatment for varices that have not yet bled is unjustified at present.
尽管硬化疗法目前是治疗急性静脉曲张出血以及静脉曲张患者长期管理中使用最广泛的方法，但其在这些患者治疗中的明确作用尚未得到最终证实。硬化疗法似乎是大多数急性静脉曲张出血患者最有效的治疗方法。治疗失败则需要进行分流术或横断术和/或去血管化手术。目前的证据支持单纯吻合器横断术或分流术（门腔分流术或门静脉与腔静脉之间的侧侧小直径聚四氟乙烯移植分流术）。在静脉曲张出血患者的长期管理中，目前最常用的治疗方法是重复硬化疗法。然而，应尽早识别治疗失败的情况。我们将治疗失败定义为那些静脉曲张难以通过硬化疗法根除，或在重复注射硬化疗法过程中反复出现危及生命的静脉曲张出血的患者。这类患者应进行门体分流术或横断术和去血管化手术。需要进一步的对照试验来确定各种治疗方式的具体适应证。目前，对尚未出血的静脉曲张进行预防性治疗是不合理的。
