門脈高壓食管胃底靜脈曲張出血的循證治療_《中國循證醫學雜志》

作者：

王一平

四川大學華西醫院消化內科,成都,610041;

關鍵詞：

肝硬化食管胃底靜脈曲張破裂出血循證治療

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肝硬化食管胃底靜脈曲張破裂出血的治療是消化領域最具有挑戰性的問題.治療出血的目的是要找到出血部位止血和預防再出血,但有時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、內鏡治療和分流術.本文介紹有關肝硬化食管胃底靜脈曲張破裂出血的治療的循證醫學證據,以供臨床醫師參考.這些證據包括:①生長抑素、血管收縮素、內鏡(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)、內鏡和外科分流預防原發性食管胃底靜脈曲張出血;③藥物(β-受體阻滯劑)、內鏡和分流(外科分流和非外科分流)預防食管胃底靜脈曲張再出血;④預防性抗生素的使用.

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. 中國循證醫學雜志, 2004, 04(3): 205-209. doi: 復制

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.
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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］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.

《中國循證醫學雜志》

門脈高壓食管胃底靜脈曲張出血的循證治療

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《中國循證醫學雜志》

門脈高壓食管胃底靜脈曲張出血的循證治療

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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