肝硬化食管胃静脉曲张的内镜治疗  

Endoscopic treatment of esophagogastric varices in cirrhosis

作　　者：尹凯歌[1] 靳晓旭 冯志杰[1] Yin Kaige;Jin Xiaoxu;Feng Zhijie(Department of Gastroenterology,the Second Hospital of Hebei Meclical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院消化内科,河北石家庄050000

出　　处：《临床荟萃》2018年第11期929-932,共4页Clinical Focus

摘　　要：肝硬化食管胃静脉曲张出血是危及生命的门脉高压并发症。食管静脉曲张一级预防策略为非选择性β受体阻滞剂(non-selective beta blockers,NSBBs)或内镜下静脉曲张套扎术(endoscopic variceal ligation,EVL),急性出血时首选EVL,其二级预防推荐NSBBs联合EVL。胃静脉曲张出血中,食管胃静脉曲张1型(gastroesophageal varices type 1,GOV1)应用EVL,食管胃静脉曲张2型(gastroesophageal varices type 2,GOV2)和孤立胃静脉曲张(isolated gastric varices,IGV)推荐内镜下组织胶注射术。预防胃静脉曲张再出血方面,内镜下组织胶注射术和经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)可应用于GOV2型和IGV,EVL、NSBBs或内镜下组织胶注射术可应用于GOV1型。胃静脉曲张一级预防可选用NSBBs或内镜下组织胶注射术。Variceal bleeding in cirrhosis is a life threatening complication of portal hypertension. The primary prophylaxis strategy of esophageal varices is non selective beta blockers （NSBBs） or endoscopic variceal ligation （EVI.）. EVI. is the first choice for acute esophageal varices bleeding. The combination of NSBBs and EVI. is the recommended management in the secondary prophylaxis. For gastric varlets bleeding, gastrocsophagcal varlets type 1 （GOV1） is recommended for EVI., gastrocsophagcal varlets type 2 （GOV2） and isolated gastric varlets （IGV） arc recommended for endoscopic tissue glue injection. In the prevention of gastric varlets rcblccding, transjugular intrahcpatic portosystcmic shunt （TIPS） can be applied to GOV2 and IGV, and EVI., NSBBs or endoscopic tissue glue injection can be applied to GOV1. NSBBs or endoscopic tissue glue injection can be used for primary prophylaxis of gastric varlets.

关 键 词：肝硬化 食管和胃静脉曲张 内镜下静脉曲张套扎术 内镜下硬化剂注射术 内镜下组织胶注射术 

分 类 号：R575.2[医药卫生—消化系统]