肝硬化食管胃静脉曲张出血:堵抑或疏?
DOI: 10.3969/j.issn.1001-5256.2021.12.004
利益冲突声明:所有作者均声明不存在利益冲突。
作者贡献声明:李振对文章设计有关键贡献;张春清参与修改文章关键问题。
Esophageal and gastric variceal bleeding in liver cirrhosis: Embolization or shunt
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摘要: 食管胃静脉曲张出血是门静脉高压严重并发症,临床上应控制食管胃静脉曲张的进展,预防和治疗食管胃静脉曲张出血,但目前静脉曲张出血相关病死率仍较高。临床处理应根据患者不同的临床特征和血流动力学特点将患者进行危险分层并采用个体化治疗,兼顾门静脉高压“堵、疏、灌”平衡,从而提高临床疗效并改善肝硬化患者预后。
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关键词:
- 肝硬化 /
- 高血压, 门静脉 /
- 食管和胃静脉曲张 /
- 门体分流术, 经颈静脉肝内
Abstract: Esophageal and gastric variceal bleeding (EGVB) is a serious complication of portal hypertension, and it is necessary to control the progression of esophageal and gastric varices in clinical practice and prevent and treat EGVB; however, the mortality rate associated with variceal rupture and bleeding remains high at present. As for clinical treatment, risk classification of patients should be performed based on clinical and hemodynamic features and individualized treatment should be adopted, taking into account the balance of "embolization, shunt, and perfusion" of portal hypertension, so as to improve the clinical outcome and prognosis of patients with liver cirrhosis. -
[1] KAMATH PS, MOOKERJEE RP. Individualized care for portal hypertension: Not quite yet[J]. J Hepatol, 2015, 63(3): 543-545. DOI: 10.1016/j.jhep.2015.07.001. [2] GARCIA-TSAO G, ABRALDES JG, BERZIGOTTI A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology, 2017, 65(1): 310-335. DOI: 10.1002/hep.28906. [3] WANG SN, WANG GC, ZHANG MY, et al. Prevention for rebleeding of esophageal varices under the guidance of hepatic venous pressure gradient[J/CD]. Chin J Digest Med Imageol(Electronic Edition), 2019, 9(6): 256-262. DOI: 10.3877/cma.j.issn.2095-2015.2019.06.005.王思宁, 王广川, 张明艳, 等. 肝静脉压力梯度指导下食管静脉曲张再出血预防方法选择[J/CD]. 中华消化病与影像杂志(电子版), 2019, 9(6): 256-262. DOI: 10.3877/cma.j.issn.2095-2015.2019.06.005. [4] LUO X, XIANG T, WU J, et al. Endoscopic Cyanoacrylate Injection vs BRTO for prevention of gastric variceal bleeding: A randomized controlled trial[J]. Hepatology, 2021, 74(4): 2074-2084. DOI: 10.1002/hep.31718. [5] TIAN X, SHI Y, HU J, et al. Percutaneous transhepatic variceal embolization with cyanoacrylate vs. transjugular intrahepatic portal systematic shunt for esophageal variceal bleeding[J]. Hepatol Int, 2013, 7(2): 636-644. DOI: 10.1007/s12072-013-9433-4. [6] WANG ZW, LIU JC, ZHAO F, et al. Comparison of the effects of TIPS versus BRTO on bleeding gastric varices: A Meta-analysis[J]. Can J Gastroenterol Hepatol, 2020, 2020: 5143013. DOI: 10.1155/2020/5143013. [7] LIU J, YANG C, HUANG S, et al. The combination of balloon-assisted antegrade transvenous obliteration and transjugular intrahepatic portosystemic shunt for the management of cardiofundal varices hemorrhage[J]. Eur J Gastroenterol Hepatol, 2020, 32(5): 656-662. DOI: 10.1097/MEG.0000000000001705. [8] CHEN S, LI X, WEI B, et al. Recurrent variceal bleeding and shunt patency: Prospective randomized controlled trial of transjugular intrahepatic portosystemic shunt alone or combined with coronary vein embolization[J]. Radiology, 2013, 268(3): 900-906. DOI: 10.1148/radiol.13120800. [9] TIAN X, SHI Y, HU J, et al. Percutaneous transhepatic variceal embolization with cyanoacrylate vs. transjugular intrahepatic portal systematic shunt for esophageal variceal bleeding[J]. Hepatol Int, 2013, 7(2): 636-644. DOI: 10.1007/s12072-013-9433-4. [10] LALEMAN W, SIMON-TALERO M, MALEUX G, et al. Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy: A multicenter survey on safety and efficacy[J]. Hepatology, 2013, 57(6): 2448-2457. DOI: 10.1002/hep.26314. [11] BOSCH J. Small diameter shunts should lead to safe expansion of the use of TIPS[J]. J Hepatol, 2021, 74(1): 230-234. DOI: 10.1016/j.jhep.2020.09.018.
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