Management of Acute Esophageal Variceal Hemorrhage

急性食道靜脈瘤出血之治療

羅錦河(Gin-Ho Lo)

《The Kaohsiung Journal of Medical Sciences》 26卷2期 (2010/02) Pp. 55-67

摘要

急性食道靜脈出血是可怕的門脈高血壓併發症。其治療近年來已經有長足的進步。傳統的治療包括血管收縮劑和食道氣球壓迫止血。血管收縮劑大約可以控制80%的出血，所以通常用來作第一線治療。使用血管收縮劑以後，內視鏡療法常被用來止血及預防早期再出血。綜合分析顯示，在急性食道靜脈瘤出血的治療，使用血管收縮劑合併內視鏡的療法比單獨使用內視鏡療法優越。食道氣球壓迫止血則可用來緊急控制洶湧出血的情況。經頸靜脈肝內血管分流術可用於很難控制的急性靜脈瘤出血的病人。另一方面，除了控制急性靜脈瘤出血之外，在預防細菌感染以及早期靜脈瘤的再出血，事先使用抗生素被證明是有用的。隨著新治療方法的出現，近年來急性食道靜脈瘤出血病人的死亡率已經有了顯著的下降。

關鍵字

急性靜脈出血 ； 結紮法 ； 靜脈曲張注射 ； 血管收縮劑

並列摘要

Acute esophageal variceal hemorrhage (AEVH) is a severe complication of portal hypertension. Its management has rapidly evolved in recent years. Traditional methods included vasoconstrictor and balloon tamponade. Vasoconstrictors were shown to control approximately 80% of the bleeding episodes and are generally used as a first-line therapy. Following the use of vasoconstrictors, endoscopic therapy is often used to arrest the bleeding varices and prevent early rebleeding. A meta-analysis showed that the combination of vasoconstrictor and endoscopic therapy is superior to endoscopic therapy alone for controlling AEVH. Balloon tamponade may be used to achieve temporary control of the hemorrhage in case of severe bleeding. A transjugular intrahepatic portosystemic stent shunt may be needed in patients with refractory acute variceal hemorrhage. Surgical intervention is now widely contraindicated during acute variceal hemorrhage, except for patients with good liver reserve. Conversely, apart from the control of acute variceal hemorrhage, prophylactic antibiotics were shown to be helpful in the prevention of bacterial infection and to prevent early variceal rebleeding. With the introduction of new treatment modalities and the measures taken to manage patients with AEVH, the mortality due to AEVH has significantly decreased in recent years.

並列關鍵字

acute variceal hemorrhage ； banding ligation ； sclerotherapy ； vasoconstrictors