• 四川大學(xué)華西醫(yī)院消化內(nèi)科,成都,610041;

肝硬化食管胃底靜脈曲張破裂出血的治療是消化領(lǐng)域最具有挑戰(zhàn)性的問題.治療出血的目的是要找到出血部位止血和預(yù)防再出血,但有時(shí)在治療上卻十分困難.目前有許多治療門脈高壓食管胃底靜脈曲張出血的方法,包括藥物治療、內(nèi)鏡治療和分流術(shù).本文介紹有關(guān)肝硬化食管胃底靜脈曲張破裂出血的治療的循證醫(yī)學(xué)證據(jù),以供臨床醫(yī)師參考.這些證據(jù)包括:①生長抑素、血管收縮素、內(nèi)鏡(套扎和硬化劑)和三腔雙囊管治療急性食管胃底靜脈曲張破裂出血;②藥物(β-受體阻滯劑)、內(nèi)鏡和外科分流預(yù)防原發(fā)性食管胃底靜脈曲張出血;③藥物(β-受體阻滯劑)、內(nèi)鏡和分流(外科分流和非外科分流)預(yù)防食管胃底靜脈曲張?jiān)俪鲅?④預(yù)防性抗生素的使用.

引用本文： 王一平. 門脈高壓食管胃底靜脈曲張出血的循證治療. 中國循證醫(yī)學(xué)雜志, 2004, 04(3): 205-209. doi: 復(fù)制

1. ［1］DeDombal FT, Clarke JR, Clamp SE, Malizia G, Kotwal MR, Morgan AG. Prognostic factors in upper GI bleeding[J]. Endoscopy, 1986; 18 ( Suppl 2 ) :6-10.
2. ［2］Bornman PC , Ktige JEJ , Terbhnche J . Management of oesophageal varices[J]. Lancet, 1994 ;343:1 079-1 084.
3. ［3］MeDonald J , Burroughs A , Feagan B . Evidence based Gastroenterologiy and heapatology[J]. BM J, 1999; 389-425.
4. ［4］Juan G. Abraldes, Jaime Bosch. Somatostatin and analogues in portal hypertension[J]. Hepatology, 2002; 35(6) :1 305.
5. ［5］Gotzsche PC, Gjomp I, Bonnen H, Somatostatin V. placebo in bleeding esophageal varices: randomised trail and meta-analysis[J]. BMJ, 1995; 310: 1 495-1498.
6. ［6］Burroughs AK, International Octerotide varices Study group.Double blind Rct of 5 day octreotide versus placebo associated with sclerotherapy for trail failures (abstract) [J]. Hepatology,1996; 24: 352A.
7. ［7］Ioannou G , Doust J , Rockey DC . Terlipressin for acute esophageal variceal hemorrhage ( Cochrane Review) [J ]. In:The Cochrane Library, Issue 1, 2003. Oxford: Update Software. Date of most recent substantive amendment: 30 October 2002.
8. ［8］Imperiale T F, Teran J C, McCullough A J. A meta-analysis of somatostatin versus vasopressin in the management of acute esophageal variceal hemorrhage [ J ]. Gastroenterology, 1995;109(4): 1 289-1 294.
9. ［9］Hartigan PM, Gebhard RL, Gregory PB, For the veterans Cooperative Variceal Slerotherapy Group. Scleroterapy for actively bleeding esophageal varices in man alcoholics with cirrhosis[J]. Gastrointest Endosc, 1997; 46:1-7.
10. ［10］D’Amico G, Pietrosi G, Tarantino I, Pagliaro L. Emergency sclerotherapy versus medical interventions for bleeding oesophageal varices in cirrhotic patients ( Cochrane Review) [ J ]. In:The Cochrane Library, Issue 1, 2003. Oxford: Update Software. Date of most recent amendment: 28 November 2001.
11. ［11］Laine L , Cook D . Endoscopic ligation compared with schlerotherapy for treatment of esophageal variceal bleeding: a meta-analysis[J]. Annals of Internal Medicine, 1995. 123(4). 280-287.
12. ［12］Heresbach D, Jacquelinet C, Noud O, Chaperon J, Bretagne J F, Gosselin M. Sclerotherapie venus ligature au cours de 1hemonagie par rupture de varices oesophagiennes: meta-analyse directe des essais randomises. ( Sclerotherapy versus banding hgation for bleeding esophageal varices: meta-analysis of randomized clinical trials) [J ]. Gastroenterologie Clinique et Biologique,1995. 19( 11 ). 914-920.
13. ［13］Gross M, Schiemann U, Muhlhofer A, Zoller W G. Meta-analysis: eflicacy of therapeutic regimens inongoing variceal bleeding[J]. Endoscopy, 2001. 33 (9). 737-746.
14. ［14］Banares R, Albillos A, Rincon D, Alonso S, Gonzalez M,Ruiz-del-Arbol L, Salcedo M, Molinero LM. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: A meta-analysis [J]. Hepatology,2002. 35(3). 609-615.
15. ［15］BoyerTD , pharmacologic treatment of Portal hypertension:Past, Present, and future [ J ]. Hepatology, 2002; 34 ( 4 ):834-839.
16. ［16］Fardy J M , Laupacis A . A meta - analysis ofprophylactic endoscopic sderotherapy for esophageal varices [J]. American Journal of Gastroenterology, 1994. 89 ( 11 ). 1 938-1 948.
17. ［17］Imperiale T F, Chalasani N. A rneta-analysis of endoscopic variceal hgation for primary prophylaxis of esophageal variceal bleeding[J]. Hepatology, 2001. 33(4). 802-807.
18. ［18］Bernard B, Lebrec D, Mathurin P, Opolon P, Poynard T.Beta-adrenergic antagonists in the prevention of gastrointestinal rebleeding in patients with cirrhosis: a meta-analysis [J ]. Heparology, 1997. 25(1). 63-70.
19. ［19］Bernard B, Lebrec D, Mathurin P, Opolon P, Poynard T.Propranolol and sclerotherapy in the prevention of gastrointestinal Rebleeding in patients with cirrhosis: a meta-analysis[J].Journal of Hepatology, 1997; 26(2). 312-324.
20. ［20］Singh P, Pooran N, Indaram A, Bank S. Combined ligarion and sclerotherapy versus ligation alone for secondary prophylaxis of esophageal variceal bleeding: a meta-analysis [ J ]. American Journal of Gastroenterology, 2002. 97 (3). 623-629.
21. ［21］Luca A, D’Amico G, La Galla R, Midiri M, Morabito A,Pagliaro L. TIPS for prevention of recurrent bleeding in patients with cirrhosis: meta-analysis of randomized clinical trials[J]. Radiology, 1999. 212(2). 411-421.
22. ［22］Papatheodoridis G V, Goulis J, Leandro G, Patch D, Burroughs A K. Transjugular intrahepatic portosystemic shunt compared with endoscopic treatment for prevention of variceal rebleeding: a meta-analysis[J]. Hepatology, 1999. 30(3). 612-622.
23. ［23］Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L. Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding[J]. In: The Coehrune Library, Issue 1,2003. Oxford: Update Software) Date of most recent substantive amendment:24 January 2002.
  1. 1. ［1］DeDombal FT, Clarke JR, Clamp SE, Malizia G, Kotwal MR, Morgan AG. Prognostic factors in upper GI bleeding[J]. Endoscopy, 1986; 18 ( Suppl 2 ) :6-10.
  2. 2. ［2］Bornman PC , Ktige JEJ , Terbhnche J . Management of oesophageal varices[J]. Lancet, 1994 ;343:1 079-1 084.
  3. 3. ［3］MeDonald J , Burroughs A , Feagan B . Evidence based Gastroenterologiy and heapatology[J]. BM J, 1999; 389-425.
  4. 4. ［4］Juan G. Abraldes, Jaime Bosch. Somatostatin and analogues in portal hypertension[J]. Hepatology, 2002; 35(6) :1 305.
  5. 5. ［5］Gotzsche PC, Gjomp I, Bonnen H, Somatostatin V. placebo in bleeding esophageal varices: randomised trail and meta-analysis[J]. BMJ, 1995; 310: 1 495-1498.
  6. 6. ［6］Burroughs AK, International Octerotide varices Study group.Double blind Rct of 5 day octreotide versus placebo associated with sclerotherapy for trail failures (abstract) [J]. Hepatology,1996; 24: 352A.
  7. 7. ［7］Ioannou G , Doust J , Rockey DC . Terlipressin for acute esophageal variceal hemorrhage ( Cochrane Review) [J ]. In:The Cochrane Library, Issue 1, 2003. Oxford: Update Software. Date of most recent substantive amendment: 30 October 2002.
  8. 8. ［8］Imperiale T F, Teran J C, McCullough A J. A meta-analysis of somatostatin versus vasopressin in the management of acute esophageal variceal hemorrhage [ J ]. Gastroenterology, 1995;109(4): 1 289-1 294.
  9. 9. ［9］Hartigan PM, Gebhard RL, Gregory PB, For the veterans Cooperative Variceal Slerotherapy Group. Scleroterapy for actively bleeding esophageal varices in man alcoholics with cirrhosis[J]. Gastrointest Endosc, 1997; 46:1-7.
  10. 10. ［10］D’Amico G, Pietrosi G, Tarantino I, Pagliaro L. Emergency sclerotherapy versus medical interventions for bleeding oesophageal varices in cirrhotic patients ( Cochrane Review) [ J ]. In:The Cochrane Library, Issue 1, 2003. Oxford: Update Software. Date of most recent amendment: 28 November 2001.
  11. 11. ［11］Laine L , Cook D . Endoscopic ligation compared with schlerotherapy for treatment of esophageal variceal bleeding: a meta-analysis[J]. Annals of Internal Medicine, 1995. 123(4). 280-287.
  12. 12. ［12］Heresbach D, Jacquelinet C, Noud O, Chaperon J, Bretagne J F, Gosselin M. Sclerotherapie venus ligature au cours de 1hemonagie par rupture de varices oesophagiennes: meta-analyse directe des essais randomises. ( Sclerotherapy versus banding hgation for bleeding esophageal varices: meta-analysis of randomized clinical trials) [J ]. Gastroenterologie Clinique et Biologique,1995. 19( 11 ). 914-920.
  13. 13. ［13］Gross M, Schiemann U, Muhlhofer A, Zoller W G. Meta-analysis: eflicacy of therapeutic regimens inongoing variceal bleeding[J]. Endoscopy, 2001. 33 (9). 737-746.
  14. 14. ［14］Banares R, Albillos A, Rincon D, Alonso S, Gonzalez M,Ruiz-del-Arbol L, Salcedo M, Molinero LM. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: A meta-analysis [J]. Hepatology,2002. 35(3). 609-615.
  15. 15. ［15］BoyerTD , pharmacologic treatment of Portal hypertension:Past, Present, and future [ J ]. Hepatology, 2002; 34 ( 4 ):834-839.
  16. 16. ［16］Fardy J M , Laupacis A . A meta - analysis ofprophylactic endoscopic sderotherapy for esophageal varices [J]. American Journal of Gastroenterology, 1994. 89 ( 11 ). 1 938-1 948.
  17. 17. ［17］Imperiale T F, Chalasani N. A rneta-analysis of endoscopic variceal hgation for primary prophylaxis of esophageal variceal bleeding[J]. Hepatology, 2001. 33(4). 802-807.
  18. 18. ［18］Bernard B, Lebrec D, Mathurin P, Opolon P, Poynard T.Beta-adrenergic antagonists in the prevention of gastrointestinal rebleeding in patients with cirrhosis: a meta-analysis [J ]. Heparology, 1997. 25(1). 63-70.
  19. 19. ［19］Bernard B, Lebrec D, Mathurin P, Opolon P, Poynard T.Propranolol and sclerotherapy in the prevention of gastrointestinal Rebleeding in patients with cirrhosis: a meta-analysis[J].Journal of Hepatology, 1997; 26(2). 312-324.
  20. 20. ［20］Singh P, Pooran N, Indaram A, Bank S. Combined ligarion and sclerotherapy versus ligation alone for secondary prophylaxis of esophageal variceal bleeding: a meta-analysis [ J ]. American Journal of Gastroenterology, 2002. 97 (3). 623-629.
  21. 21. ［21］Luca A, D’Amico G, La Galla R, Midiri M, Morabito A,Pagliaro L. TIPS for prevention of recurrent bleeding in patients with cirrhosis: meta-analysis of randomized clinical trials[J]. Radiology, 1999. 212(2). 411-421.
  22. 22. ［22］Papatheodoridis G V, Goulis J, Leandro G, Patch D, Burroughs A K. Transjugular intrahepatic portosystemic shunt compared with endoscopic treatment for prevention of variceal rebleeding: a meta-analysis[J]. Hepatology, 1999. 30(3). 612-622.
  23. 23. ［23］Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L. Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding[J]. In: The Coehrune Library, Issue 1,2003. Oxford: Update Software) Date of most recent substantive amendment:24 January 2002.