门脉高压胃底静脉曲张防治进展  

Management of gastric varices associated with portal hypertension

作　　者：姜琴[1] 孔德润[1] 

机构地区：[1]安徽医科大学第一附属医院消化内科,安徽省合肥市237000

出　　处：《世界华人消化杂志》2016年第8期1145-1152,共8页World Chinese Journal of Digestology

基　　金：国家自然科学基金资助项目;No.81271736~~

摘　　要：同食管曲张静脉相比,胃底静脉曲张发生率较低,约占肝硬化出血的10%,但其一旦出血,比食管静脉曲张出血更严重,易反复发生出血,并且有更高的病死率.目前国内研究主要关注食管静脉曲张出血的处理,但关于胃底静脉曲张治疗的研究相对较少,且其规范化治疗也未形成统一意见.内镜下组织胶黏合剂注射治疗是控制胃静脉曲张出血最常用的治疗方法.经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)可用于急性胃静脉曲张出血和二级预防中.球囊导管逆行性静脉栓塞术(balloon-occluded retrograde transvenous obliteration,BRTO)可用于胃静脉曲张伴胃肾分流患者.近年来,门脉高压胃底静脉曲张出血的内镜下治疗及介入治疗已有很大发展,本文就其治疗策略、疗效及并发症作一简要综述.The rate of gastric variceal bleeding is signih＇cantlylower than that of esophageal variceal bleeding. Although gastric variceal bleeding occurs in only 10% of cirrhotic patients with hemorrhage, the bleeding is usually more severe, and is associated with higher mortality. To date, the majority of studies have focused on the treatment of esophageal variceal bleeding, but there were few studies on the treatment of gastric varices. As a result, there is still no standardized treatment for gastric varices. Endoscopic injection of cyanoacrylate is currently the optimum approach to control active bleeding from gastric varices. Transjugular intrahepatic portosystemic shunt （TIPS） can be used in acute gastric variceal bleeding and secondary prophylaxis. Balloon- occluded retrograde transvenous obliteration （BRTO） may be used in patients with gastric varices associated with a gastrorenal shunt. In recent years, endoscopic therapy and radiologic therapy have been developed for the treatment of patients with gastric variceal bleeding associated with portal hypertension. Here we describe the optimum treatment strategies for gastric variceal bleeding associated with portal hypertension as well as their therapeutic effects and complications.

关 键 词：肝硬化 高血压 门静脉 门体分流术 经颈静脉肝内 食管胃静脉曲张 组织胶治疗 

分 类 号：R575.2[医药卫生—消化系统]