Orloff M J
Can J Surg. 1979 Nov;22(6):550-3.
The cirrhotic patient with acute bleeding from esophageal varices has less than a 50% chance of leaving the hospital alive; the outlook for survival is so poor that even desperate measures are worthwhile. Some traditional nonsurgical methods for the control of the bleeding are either ineffective at worst or temporary at best. Balloon tamponade is not recommended at all, but intravenously administered vasopressin may be helpful in allowing the necessary diagnostic investigations to be completed. Most important at this stage are the measures necessary to improve the general status of the patient--restoration of blood volume with fresh blood, prevention of ammonia intoxication, support of the liver, correction of metabolic alkalosis and treatment of the hyperdynamic state with digitalis and cardiotonic drugs. Controlling the bleeding is not the greatest problem--the greatest problem is achieving survival of a critically ill patient who undergoes a formidable operation (e.g., variceal ligation stops the bleeding, but is itself an operation of considerable magnitude). In our hands emergency shunting is the best treatment providing a definitive procedure with the highest 10-year survival rate and the lowest complication rate.
患有食管静脉曲张急性出血的肝硬化患者存活出院的几率不到50%；生存前景如此渺茫，以至于即使是孤注一掷的措施也值得一试。一些传统的控制出血的非手术方法，往最坏的方面说无效，往最好的方面说也只是暂时有效。根本不推荐使用气囊压迫止血法，但静脉注射加压素可能有助于完成必要的诊断性检查。现阶段最重要的是改善患者总体状况所需的措施——用新鲜血液补充血容量、预防氨中毒、支持肝脏功能、纠正代谢性碱中毒以及用洋地黄和强心药物治疗高动力状态。控制出血并非最大的问题——最大的问题是让一名危重症患者在接受一场艰巨的手术（例如，曲张静脉结扎术能止血，但本身就是一场规模相当大的手术）后存活下来。在我们手中，急诊分流术是最佳治疗方法，它能提供一种确定性手术，10年生存率最高且并发症发生率最低。
