Stringer M D, Howard E R
Department of Surgery, King's College Hospital, London.
Gut. 1994 Feb;35(2):257-9. doi: 10.1136/gut.35.2.257.
A consecutive series of 36 children with bleeding from oesophageal varices secondary to extrahepatic portal hypertension was successfully treated by endoscopic injection sclerotherapy and followed up over a mean period of 8.7 years after variceal obliteration. There were no deaths from portal hypertension or its treatment and morbidity related to oesophageal sclerotherapy was minimal. Endoscopic injection sclerotherapy alone proved safe and effective in controlling variceal bleeding from portal hypertension in over 80% of the children. Recurrent variceal bleeding developed in 10 (31%) patients but half of these were effectively treated by further sclerotherapy. Gastric variceal bleeding unresponsive to sclerotherapy necessitated successful portosystemic shunt surgery in four (13%) patients. Two children required splenectomy for painful splenomegaly. In most children injection sclerotherapy is the best treatment for the primary management of bleeding oesophageal varices, reserving portosystemic shunting or other surgical procedures for those with bleeding from gastrointestinal varices.
连续36例因肝外门静脉高压继发食管静脉曲张出血的儿童，通过内镜注射硬化疗法成功治疗，并在静脉曲张闭塞后平均随访8.7年。没有因门静脉高压或其治疗导致的死亡，与食管硬化疗法相关的发病率极低。单独的内镜注射硬化疗法在超过80%的儿童中被证明对控制门静脉高压引起的静脉曲张出血安全有效。10例（31%）患者出现复发性静脉曲张出血，但其中一半通过进一步硬化疗法得到有效治疗。4例（13%）对硬化疗法无反应的胃静脉曲张出血患者成功进行了门体分流手术。两名儿童因脾肿大疼痛需要行脾切除术。对于大多数儿童，注射硬化疗法是治疗食管静脉曲张出血的最佳初始治疗方法，而门体分流或其他手术方法则适用于胃肠道静脉曲张出血的患者。
