失代偿期门静脉高压并发食管胃静脉曲张出血的防治:内镜vs经颈静脉肝内门体分流术  

Comparison of endoscopic therapy and TIPS in prophylaxis and treatment of variceal bleeding in decompensated portal hypertension

作　　者：刘梦莹[1] 李伟之[1] 李培杰[1] 马富权 陈羽玲 孙焕焕 高恬恬 薛挥[1,2] LIU Mengying;LI Weizhi;LI Peijie;MA Fuquan;CHEN Yuling;SUN Huanhuan;GAO Tiantian;XUE Hui(Department of Gastroenterology,The Frist Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Xi’an Jiaotong University Health Science Center,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院消化内科,西安710061 [2]西安交通大学医学部,西安710061

出　　处：《临床肝胆病杂志》2023年第7期1529-1534,共6页Journal of Clinical Hepatology

基　　金：陕西省重点研发计划一般项目(2020SF-073,2021SF-126,2018SF-051,2019SF-195)

摘　　要：食管胃静脉曲张出血(EGVB)是失代偿期门静脉高压症的主要并发症之一,尤其是肝硬化患者,病死率很高。EGVB以药物联合内镜标准防治为主;经颈静脉肝内门体分流术(TIPS)联合曲张静脉栓塞术在某些高危患者中也可优先选择,以肝静脉压力梯度为参考采取个体化诊治门静脉高压应当成为最新共识和主要策略。本文主要对失代偿期门静脉高压EGVB患者的内镜下防治及TIPS防治的相关适应证选择、并发症发生率及优劣予以综述。Esophagogastric variceal bleeding(EGVB)is one of the main complications of decompensated portal hypertension,especially in patients with liver cirrhosis,and it often has a high mortality rate.Medication combined with endoscopy is the main prevention and treatment method for EGVB,while transjugular intrahepatic portosystemic shunt(TIPS)combined with variceal embolization can also be selected for some high-risk patients,and individualized diagnosis and treatment of portal hypertension based on hepatic venous pressure gradient should become the latest consensus and the main strategy.This article mainly reviews endoscopic therapy and TIPS for the prevention and treatment of EGVB patients with decompensated portal hypertension in terms of selection of indications,incidence rate of complications,and respective advantages and disadvantages.

关 键 词：门静脉高压 肝硬化 食管和胃静脉曲张 出血 门体分流术 经颈静脉肝内 

分 类 号：R575.2[医药卫生—消化系统]