肝硬化门脉高压症内科治疗的选择与评价肝硬化门脉高压症内科治疗的选择与评价
门脉高压症;心得安;生长抑素及其类似物;经颈静脉肝内门腔分流术;内镜治疗,丁惠国,丁惠国,通讯作者:,Evaluationontreatmentoflivercirrhosiswithportalhypertensio
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丁惠国, 首都医科大学附属北京佑安医院肝病消化科 北京市 100069
丁惠国, 首都医科大学博士研究生导师, 北京佑安医院肝病消化科主任, 北京中西医结合学会肝病专业委员会委员, 研究方向为慢性肝病及其并发症的基础与临床.
北京市自然科学基金项目, No. 7062032
通讯作者: 丁惠国, 100069, 北京市, 首都医科大学附属北京佑安医院肝病消化科. dinghuiguo@medmail.com.cn
电话: 010-83997155 传真: 010-63295525
收稿日期: 2007-05-01 接受日期: 2007-05-10
Evaluation on treatment of liver cirrhosis with portal hypertension
Hui-Guo Ding
Hui-Guo Ding, Department of Gastroenterology (hepatology), You’an Hospital Affiliated to Capital Medical University, Beijing 100069, China
Supported bythe Natural Science Foundation of Beijing, No. 7062032
Correspondence to:Department of Gastroenterology (hepatology), You’an Hospital Affiliated to Capital Medical University, Beijing 100069, China. dinghuiguo@medmail.com.cn
Received:2007-05-01 Accepted:2007-05-10
Abstract
TGastroesophageal variceal bleeding (EVB) is a frequent and life-threatening complication in cirrhotic patients with portal hypertension. Despite advances in endoscopic and pharmacologic treatment for EVB, it remains an unacceptably high mortality and risk of rebleeding. For primary and secondary prevention of EVB, non-surgical treatment strategies are still particularly challenging. Nonselective beta blockade, propranolol, is considered the first choice in the primary prophylaxis of EVB. Somatostatin and its analogue, octreotide, have been used as first-line treatment for EVB. The rate of controlling EVB accounts for 85%-90%, pituitrin, a vasopressin has essentially been abandoned because of side effects. Available treatments for prevention of rebleeding have been recommended, such as the beta blockers, nitrates (especially used in combination with beta blockers), and mechanical therapies such as endoscopic sclerotherapy/band ligation and transjugular intrahepatic portosystemic shunt (TIPS). TIPS should not be used as a first-line treatment for EVB, but as a rescue for medical or endoscopic treatment failure ......
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