肝硬化食管胃底静脉曲张的内镜诊断治疗——从指南到临床实践  

Endoscopic diagnosis and treatment of esophageal and gastric varices in patients with liver cirrhosis:from guidelines to clinical practice

作　　者：丁惠国[1] 张世斌[1] 李磊[1] 李鹏[1] 张月宁[1] 王贞彪[1] DING Huiguo ZHANG Shibin LI Lei et al(Department of Hepatology and Gastroenterology, Beifing YouAn Hospital, Capital Medical U- niversity, Bering 100069, China)

机构地区：[1]首都医科大学附属北京佑安医院肝病消化中心,北京100069

出　　处：《临床肝胆病杂志》2017年第3期454-457,共4页Journal of Clinical Hepatology

基　　金：北京市医院管理局感染消化内科重点专业(ZYLX201610);登峰人才团队培养计划(DFL20151602)

摘　　要：肝硬化食管胃底静脉曲张出血是临床常见、病死率高的消化系统急重症,内镜是诊治的主要手段。选择适宜的内镜技术及时诊断和有效治疗是降低其病死率的关键。根据国内肝硬化门静脉高压症临床诊治相关指南及最新临床证据,简述了内镜在肝硬化食管胃底静脉曲张及其出血的诊断和治疗中的作用,包括内镜筛查与治疗时机、内镜硬化剂与套扎治疗方法的选择、内镜治疗失败的挽救措施、内镜治疗并发症及其处理。肝静脉压力梯度指导下,可提高个体化的内镜和(或)药物防治肝硬化食管胃底静脉曲张出血的效果。总之,内镜是肝硬化食管胃底静脉曲张出血诊治的主要手段,研究早期预测内镜治疗效果的因素,规范内镜诊治技术,对提高内镜治疗的效果及安全性具有重要意义。Gastroesophageal variceal bleeding in patients with liver cirrhosis is a common acute gastrointestinal disease in clinical practice with a high mortality rate,and endoscopy is a main method for the diagnosis and treatment of this disease.Timely diagnosis and effective treatment with appropriate endoscopic techniques are the key to reducing mortality rate.With reference to related diagnosis and treatment guidelines and the latest clinical evidence for cirrhotic portal hypertension in China,this article summarizes the role of endoscopy in the diagnosis and treatment of esophageal and gastric varices and bleeding in patients with liver cirrhosis,including endoscopic screening and timing of treatment,selection of endoscopic sclerosing agents and endoscopic variceal ligation,salvage measures for endoscopic treatment failure,and complications and related treatment measures.Hepatic venous pressure gradient helps to improve the effect of endoscopy and/or drugs in the prevention and treatment of gastroesophageal variceal bleeding in patients with liver cirrhosis.In a word,endoscopy is the main method for the diagnosis and treatment of gastroesophageal variceal bleeding in patients with liver cirrhosis,and the research and application of factors for early prediction of the effect of endoscopic therapy and standardization of endoscopic diagnosis and treatment techniques are of great significance in improving the effect and safety of endoscopic therapy.

关 键 词：肝硬化 食管和胃静脉曲张 内窥镜检查 诊断 治疗 

分 类 号：R575.2[医药卫生—消化系统]