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中华消化病与影像杂志(电子版) ›› 2022, Vol. 12 ›› Issue (03) : 162 -166. doi: 10.3877/cma.j.issn.2095-2015.2022.03.009

综述

肝硬化胃静脉曲张破裂出血的治疗进展
赵媛媛1, 张春清2,()   
  1. 1. 250021 济南,山东第一医科大学附属省立医院消化内科
    2. 250021 济南,山东第一医科大学附属省立医院消化内科;250021 济南,山东大学省立医院消化内科
  • 收稿日期:2021-11-17 出版日期:2022-06-01
  • 通信作者: 张春清
  • 基金资助:
    国家自然科学基金委员会(81970533)

Progress in the treatment of gastric variceal bleeding in liver cirrhosis

Yuanyuan Zhao1, Chunqing Zhang2,()   

  1. 1. Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
    2. Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China; Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
  • Received:2021-11-17 Published:2022-06-01
  • Corresponding author: Chunqing Zhang
引用本文:

赵媛媛, 张春清. 肝硬化胃静脉曲张破裂出血的治疗进展[J/OL]. 中华消化病与影像杂志(电子版), 2022, 12(03): 162-166.

Yuanyuan Zhao, Chunqing Zhang. Progress in the treatment of gastric variceal bleeding in liver cirrhosis[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2022, 12(03): 162-166.

胃静脉曲张破裂出血是肝硬化患者上消化道出血常见的原因,虽然胃静脉曲张破裂出血的发生率比食管静脉曲张破裂出血低,但病情更严重,死亡率更高,因此预防和治疗胃静脉曲张破裂出血非常重要。药物治疗、内镜治疗、介入治疗、外科手术等都是治疗该病的有效方法,提高了患者的生存率。本文针对胃静脉曲张的药物、内镜和介入疗法的现状及进展做一综述。

Gastric variceal bleeding(GVB)is a common cause of upper gastrointestinal bleeding in patients with liver cirrhosis.With a lower incidence and higher mortality than esophageal variceal bleeding(EVB), GVB is more severe.Thus, prevention and treatment of GVB is very important.There are several approaches to GVB treatment, such as drugs, endoscopic treatment, interventional and surgical operation, which improve the survival rate of patients.This article reviews the current status and progress of drug, endoscope and interventional treatment for GVB.

1
Goral V, Ylmaz N.Current Approaches to the Treatment of Gastric Varices:Glue,Coil Application,TIPS,and BRTO[J].Medicina(Kaunas)201955(7):335.
2
Garcia-Pagán J C, Barrufet M, Cardenas A,et al.Management of gastric varices[J].Clin Gastroenterol Hepatol201412(6):919-928.e911;quiz e951-912.
3
Kim T, Shijo H, Kokawa H,et al.Risk factors for hemorrhage from gastric fundal varices[J].Hepatology199725(2):307-312.
4
Sarin S K, Lahoti D, Saxena S P,et al.Prevalence,classification and natural history of gastric varices:a long-term follow-up study in 568 portal hypertension patients[J].Hepatology199216(6):1343-1349.
5
Garcia-Tsao G, Abraldes J G, Berzigotti A,et al.Portal hypertensive bleeding in cirrhosis:Risk stratification,diagnosis,and management:2016 practice guidance by the American Association for the study of liver diseases[J].Hepatology201765(1):310-335.
6
中华医学会肝病学分会,中华医学会消化病学分会,中华医学会内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].临床肝胆病杂志201632(2):203-219.
7
EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis [J].J Hepatol201869(2):406-460.
8
Mishra S R, Sharma B C, Kumar A,et al.Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers:a randomized controlled trial[J].J Hepatol201154(6):1161-1167.
9
de Franchis R.Expanding consensus in portal hypertension:Report of the Baveno VI Consensus Workshop:Stratifying risk and individualizing care for portal hypertension[J].J Hepatol201563(3):743-752.
10
Odutayo A, Desborough M J, Trivella M,et al.Restrictive versus liberal blood transfusion for gastrointestinal bleeding:a systematic review and meta-analysis of randomised controlled trials[J].Lancet Gastroenterol Hepatol20172(5):354-360.
11
Villanueva C, Colomo A, Bosch A,et al.Transfusion strategies for acute upper gastrointestinal bleeding[J].N Engl J Med2013368(1):11-21.
12
Zhou G P, Jiang Y Z, Sun L Y,et al.Early transjugular intrahepatic portosystemic shunt for acute variceal bleeding:a systematic review and meta-analysis[J].Eur Radiol202131(7):5390-5399.
13
Lv Y, Zuo L, Zhu X,et al.Identifying optimal candidates for early TIPS among patients with cirrhosis and acute variceal bleeding:a multicentre observational study[J].Gut201968(7):1297-1310.
14
Bosch J.Carvedilol for portal hypertension in patients with cirrhosis[J].Hepatology201051(6):2214-2218.
15
Bañares R, Moitinho E, Matilla A,et al.Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosis[J].Hepatology200236(6):1367-1373.
16
Chen W C, Hsin I F, Chen P H,et al.Addition of Carvedilol to Gastric Variceal Obturation Does Not Decrease Recurrence of Gastric Variceal Bleeding in Patients With Cirrhosis[J].Clin Gastroenterol Hepatol201917(11):2356-2363.e2352.
17
Chevallier O, Guillen K, Comby P O,et al.Safety,Efficacy,and Outcomes of N-Butyl Cyanoacrylate Glue Injection through the Endoscopic or Radiologic Route for Variceal Gastrointestinal Bleeding:A Systematic Review and Meta-Analysis[J].J Clin Med202110(11).
18
Ríos Castellanos E, Seron P, Gisbert J P,et al.Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension[J].Cochrane Database Syst Rev2015,(5):CD010180.
19
周庆南,郭先文,张国,等.消化内镜下治疗胃静脉曲张的研究进展[J].中国临床新医学202114(6):620-624.
20
Al-Khazraji A, Curry M P.The current knowledge about the therapeutic use of endoscopic sclerotherapy and endoscopic tissue adhesives in variceal bleeding[J].Expert Rev Gastroenterol Hepatol201913(9):893-897.
21
Lee T H, Shih L N.Clinical experience of endoscopic banding ligation for bleeding gastric varices[J].Hepatogastroenterology200855(82/83):766-769.
22
Mohan B P, Chandan S, Khan S R,et al.Efficacy and safety of endoscopic ultrasound-guided therapy versus direct endoscopic glue injection therapy for gastric varices:systematic review and meta-analysis[J].Endoscopy202052(4):259-267.
23
Binmoeller K F, Weilert F, Shah J N,et al.EUS-guided transesophageal treatment of gastric fundal varices with combined coiling and cyanoacrylate glue injection(with videos)[J].Gastrointest Endosc201174(5):1019-1025.
24
Caldwell S H, Hespenheide E E, Greenwald B D,et al.Enbucrilate for gastric varices:extended experience in 92 patients[J].Aliment Pharmacol Ther200726(1):49-59.
25
梅长红,李会贤,王曦,等.内镜下金属钛夹联合组织胶注射治疗胃底静脉曲张22例[J].安徽医药201923(12):2420-2423,2546.
26
王敏,李会贤,叶东,等.钛夹联合组织黏合剂治疗胃静脉曲张的多中心临床研究[J].中华全科医学202018(8):1290-1293,1379.
27
Lo G H, Liang H L, Chen W C,et al.A prospective,randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding[J].Endoscopy200739(8):679-685.
28
Procaccini N J, Al-Osaimi A M, Northup P,et al.Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding:a single-center U.S.analysis[J].Gastrointest Endosc200970(5):881-887.
29
Park J K, Saab S, Kee S T,et al.Balloon-Occluded Retrograde Transvenous Obliteration(BRTO)for Treatment of Gastric Varices:Review and Meta-Analysis[J].Dig Dis Sci201560(6):1543-1553.
30
Akahoshi T, Hashizume M, Tomikawa M,et al.Long-term results of balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding and risky gastric varices:a 10-year experience[J].J Gastroenterol Hepatol200823(11):1702-1709.
31
Hiraga N, Aikata H, Takaki S,et al.The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration[J].J Gastroenterol200742(8):663-672.
32
Kim S K, Lee K A, Sauk S,et al.Comparison of Transjugular Intrahepatic Portosystemic Shunt with Covered Stent and Balloon-Occluded Retrograde Transvenous Obliteration in Managing Isolated Gastric Varices[J].Korean J Radiol201718(2):345-354.
33
Paleti S, Nutalapati V, Fathallah J,et al.Balloon-Occluded Retrograde Transvenous Obliteration(BRTO)Versus Transjugular Intrahepatic Portosystemic Shunt(TIPS)for Treatment of Gastric Varices Because of Portal Hypertension:A Systematic Review and Meta-Analysis[J].J Clin Gastroenterol202054(7):655-660.
34
Sabri S S, Abi-Jaoudeh N, Swee W,et al.Short-term rebleeding rates for isolated gastric varices managed by transjugular intrahepatic portosystemic shunt versus balloon-occluded retrograde transvenous obliteration[J].J Vasc Interv Radiol201425(3):355-361.
35
Saad W E, Wagner C C, Lippert A,et al.Protective value of TIPS against the development of hydrothorax/ascites and upper gastrointestinal bleeding after balloon-occluded retrograde transvenous obliteration(BRTO)[J].Am J Gastroenterol2013108(10):1612-1619.
36
Bian S, Tian X G, Hu J H,et al.Percutaneous transhepatic variceal embolization combined with endoscopic ligation for the prevention of variceal rebleeding[J].J Dig Dis201314(7):388-395.
37
Zhang C Q, Liu F L, Liang B,et al.A modified percutaneous transhepatic variceal embolization with 2-octyl cyanoacrylate versus endoscopic ligation in esophageal variceal bleeding management:randomized controlled trial[J].Dig Dis Sci200853(8):2258-2267.
38
Zhang C Q, Liu F L, Liang B,et al.A modified percutaneous transhepatic varices embolization with 2-octyl cyanoacrylate in the treatment of bleeding esophageal varices[J].J Clin Gastroenterol200943(5):463-469.
39
Wang J, Tian X G, Li Y,et al.Comparison of modified percutaneous transhepatic variceal embolization and endoscopic cyanoacrylate injection for gastric variceal rebleeding[J].World J Gastroenterol201319(5):706-714.
40
Zhang K, Sun X, Wang G,et al.Treatment outcomes of percutaneous transhepatic variceal embolization versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding[J].Medicine(Baltimore)201998(18):e15464.
41
Jang S Y, Kim G H, Park S Y,et al.Clinical outcomes of balloon-occluded retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage in Korean patients with liver cirrhosis:a retrospective multicenter study[J].Clin Mol Hepatol201218(4):368-374.
42
Wang G, Meng D, Huang G,et al.Balloon-Assisted Percutaneous Transhepatic Antegrade Embolization with 2-Octyl Cyanoacrylate for the Treatment of Isolated Gastric Varices with Large Gastrorenal Shunts[J].Biomed Res Int20192019:2674758.
43
Watanabe M, Shiozawa K, Ikehara T,et al.Short-term effects and early complications of balloon-occluded retrograde transvenous obliteration for gastric varices[J].ISRN Gastroenterol20122012:919371.
44
Choudhuri G, Chetri K, Bhat G,et al.Long-term efficacy and safety of N-butylcyanoacrylate in endoscopic treatment of gastric varices[J].Trop Gastroenterol201031(3):155-164.
45
Bai M, Qi X S, Yang Z P,et al.EVS vs TIPS shunt for gastric variceal bleeding in patients with cirrhosis:A meta-analysis[J].World J Gastrointest Pharmacol Ther20145(2):97-104.
46
Luo X, Xiang T, Wu J,et al.Endoscopic Cyanoacrylate Injection Versus Balloon-Occluded Retrograde Transvenous Obliteration for Prevention of Gastric Variceal Bleeding:A Randomized Controlled Trial[J].Hepatology202174(4):2074-2084.
47
Fernandes A, Almeida N, Ferreira A M,et al.Left-Sided Portal Hypertension:A Sinister Entity[J].GE Port J Gastroenterol201522(6):234-239.
48
Moossa A R, Gadd M A.Isolated splenic vein thrombosis[J].World J Surg19859(3):384-390.
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