Farges O, Boutelier P
J Chir (Paris). 1986 Feb;123(2):129-40.
The increasing popularity of treatment of esophageal varices by endoscopic sclerosis is the result of two factors. First, the principle underlying the procedure, which tends towards selective occlusion of the submucous venous network at the esophagogastric junction, where the risk of rupture is maximal, while respecting other periesophageal bypass pathways of portal blood. Second, the improvement of the apparatus used, thus simplifying the operation and reducing risks, and the improved definition of the limitations of medicosurgical treatment of portal hypertension. Results may be altered by several variables: protocol of injections, particularly intra- or paravascular site of injection, nature of sclerosing agent, type of endoscopy performed, size of varices, etiology of portal hypertension and severity of hepatic lesion and especially the relation between time of operation and the hemorrhagic episode. Hemostasis of a ruptured esophageal varix was obtained in 75 to 100% of cases. Adequate follow up and repeat injections are essential for varicose recurrences (long-term relapse rate = 50%) to avoid hemorrhagic complications.
内镜下硬化治疗食管静脉曲张越来越受欢迎，这是两个因素导致的结果。首先，该手术的基本原理是倾向于选择性闭塞食管胃交界处的黏膜下静脉网络，此处破裂风险最大，同时保留门静脉血的其他食管周围旁路途径。其次，所用器械的改进，从而简化了操作并降低了风险，以及对门静脉高压药物外科治疗局限性的更明确界定。结果可能会因几个变量而改变：注射方案，特别是血管内或血管旁注射部位、硬化剂的性质、所进行的内镜检查类型、静脉曲张的大小、门静脉高压的病因、肝脏病变的严重程度，尤其是手术时间与出血发作之间的关系。75%至100%的病例实现了破裂食管静脉曲张的止血。对于静脉曲张复发（长期复发率 = 50%），充分的随访和重复注射对于避免出血并发症至关重要。
