Terlipressin Combined with Somatostatin in Treatment of Hemorrhage of Esophagogastric Varices Due to Portal Hypertension in Liver Cirrhosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 张磊 , 章锐 , 刘飞龙 ,  张万广

华中科技大学同济医学院附属同济医院肝脏外科中心（湖北武汉 430030）;

Corresponding author：

张万广, Email: wgzhuang@medmail.com.cn

Keywords：

特利加压素; 生长抑素; 门静脉高压症; 食管胃底静脉曲张; 出血

DOI：

10.7507/1007-9424.20140341

Video：

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目的观察特利加压素联合生长抑素治疗肝硬变门静脉高压食管胃底曲张静脉破裂出血的效果。方法我院2008年3月至2012年8月期间收治的47例肝硬变门静脉高压食管胃底曲张静脉破裂出血患者入院时采用掷硬币法被随机分为特利加压素＋生长抑素组（n=24）和生长抑素组（n=23），分别给予联合用药或单独使用生长抑素，计算24 h止血率、总止血率、1周再出血率、1周死亡率，观察不良反应发生、尿量及腹水量情况。结果特利加压素＋生长抑素组24 h止血率、总止血率和不良反应发生率明显高于生长抑素组（P＜0.05），1周再出血率明显低于生长抑素组（P＜0.05），2组1周死亡率比较差异无统计学意义（P＞0.05），特利加压素＋生长抑素组尿量明显多于生长抑素组（P＜0.05），盆腔腹水量明显少于生长抑素组（P＜0.05）。结论特利加压素联合生长抑素用于肝硬变门静脉高压食管胃底曲张静脉破裂出血止血效果确切，可以明显降低死亡率；虽然其不良反应发生率略高，但均可以控制。

Citation： 张磊, 章锐, 刘飞龙, 张万广. Terlipressin Combined with Somatostatin in Treatment of Hemorrhage of Esophagogastric Varices Due to Portal Hypertension in Liver Cirrhosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(11): 1436-1438. doi: 10.7507/1007-9424.20140341 Copy

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2.	陈孝平, 陈义发.我国门静脉高压症外科治疗进展[J].国际外科学杂志, 2008, 35(7):435-436.
3.	Gotoh Y, Iwakiri R, Sakata Y, et al.Evaluation of endoscopic variceal ligation in prophylactic therapy for bleeding of oesophageal varices:a prospective, controlled trial compared with endoscopic injection sclerotherapy[J].J Gastroenterol Hepatol, 1999, 14(3):241-244.
4.	Lo GH, Lai KH, Cheng JS, et al.A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices[J].Hepatology, 2001, 33(5):1060-1064.
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6.	陈孝平, 汪建平.外科学[M].第8版.北京:人民卫生出版社, 2013:437-443.
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10.	任祖海, 叶启发, 余伟平, 等.terlipressin对肝大部切除术后早期小体积肝功能保护机制的研究[J].中国普通外科杂志, 2010, 19(7):756-762.
11.	郭莲怡, 王桂君.生长抑素联合特利加压素治疗肝硬化急性食管静脉曲张破裂出血患者的临床观察[J].中国药房, 2012, 23(32):2998-3000.
12.	Krag A, Borup T, Møller S, et al.Efficacy and safety of terlipressin in cirrhotic patients with variceal bleeding or hepatorenal syndrome[J].Adv Ther, 2008, 25(11):1105-1140.
13.	Ginès P, Guevara M.Therapy with vasoconstrictor drugs in cirrhosis:The time has arrived[J].Hepatology, 2007, 46(6):1685-1687.
14.	Rodríguez E, Elia C, Solà E, et al.Terlipressin and albumin for type-1 hepatorenal syndrome associated with sepsis[J].J Hepatol, 2014, 60(5):955-961.
15.	张志伟, 陈孝平.思他宁治疗肝硬化门静脉高压食管胃底曲张静脉破裂大出血的临床疗效观察[J].临床外科杂志, 2003, 11(5):311-312.
16.	Villanueva C, Ortiz J, Sàbat M, et al.Somatostatin alone or combined with emergency sclerotherapy in the treatment of acute esophageal variceal bleeding:a prospective randomized trial[J].Hepatology, 1999, 30(2):384-389.
17.	McCormick PA, Biagini MR, Dick R, et al.Octreotide inhibits the meal-induced increases in the portal venous pressure of cirrhotic patients with portal hypertension:a double-blind, placebo-controlled study[J].Hepatology, 1992, 16(5):1180-1186.
18.	Sundriyal D, Kumar N, Patnaik I, et al.Terlipressin induced ischaemia of skin[J].BMJ Case Rep, 2013, 2013.Pii:bcr2013010050.doi:10.1136/bcr-2013-010050.
19.	Kim HR, Lee YS, Yim HJ, et al.Severe ischemic bowel necrosis caused by terlipressin during treatment of hepatorenal syndrome[J].Clin Mol Hepatol, 2013, 19(4):417-420.

1. 陈孝平.门静脉高压症外科治疗现状[J].腹部外科, 2007, 20(2):70-71.
2. 陈孝平, 陈义发.我国门静脉高压症外科治疗进展[J].国际外科学杂志, 2008, 35(7):435-436.
3. Gotoh Y, Iwakiri R, Sakata Y, et al.Evaluation of endoscopic variceal ligation in prophylactic therapy for bleeding of oesophageal varices:a prospective, controlled trial compared with endoscopic injection sclerotherapy[J].J Gastroenterol Hepatol, 1999, 14(3):241-244.
4. Lo GH, Lai KH, Cheng JS, et al.A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices[J].Hepatology, 2001, 33(5):1060-1064.
5. Sarin SK, Jain AK, Jain M, et al.A randomized controlled trial of cyanoacrylate versus alcohol injection in patients with isolated fundic varices[J].Am J Gastroenterol, 2002, 97(4):1010-1015.
6. 陈孝平, 汪建平.外科学[M].第8版.北京:人民卫生出版社, 2013:437-443.
7. Sarin SK, Sharma P.Terlipressin:an asset for hepatologists![J].Hepatology, 2011, 54(2):724-728.
8. Wang YK, Hwang DY, Wang SS, et al.Terlipressin-induced hyponatremic encephalopathy in a noncirrhotic patient[J].Kaohsiung J Med Sci, 2013, 29(12):691-694.
9. 王维民, 王歆光.药物在防治门静脉高压症上消化道出血中的作用[J].中华外科杂志, 2007, 45(13):865-867.
10. 任祖海, 叶启发, 余伟平, 等.terlipressin对肝大部切除术后早期小体积肝功能保护机制的研究[J].中国普通外科杂志, 2010, 19(7):756-762.
11. 郭莲怡, 王桂君.生长抑素联合特利加压素治疗肝硬化急性食管静脉曲张破裂出血患者的临床观察[J].中国药房, 2012, 23(32):2998-3000.
12. Krag A, Borup T, Møller S, et al.Efficacy and safety of terlipressin in cirrhotic patients with variceal bleeding or hepatorenal syndrome[J].Adv Ther, 2008, 25(11):1105-1140.
13. Ginès P, Guevara M.Therapy with vasoconstrictor drugs in cirrhosis:The time has arrived[J].Hepatology, 2007, 46(6):1685-1687.
14. Rodríguez E, Elia C, Solà E, et al.Terlipressin and albumin for type-1 hepatorenal syndrome associated with sepsis[J].J Hepatol, 2014, 60(5):955-961.
15. 张志伟, 陈孝平.思他宁治疗肝硬化门静脉高压食管胃底曲张静脉破裂大出血的临床疗效观察[J].临床外科杂志, 2003, 11(5):311-312.
16. Villanueva C, Ortiz J, Sàbat M, et al.Somatostatin alone or combined with emergency sclerotherapy in the treatment of acute esophageal variceal bleeding:a prospective randomized trial[J].Hepatology, 1999, 30(2):384-389.
17. McCormick PA, Biagini MR, Dick R, et al.Octreotide inhibits the meal-induced increases in the portal venous pressure of cirrhotic patients with portal hypertension:a double-blind, placebo-controlled study[J].Hepatology, 1992, 16(5):1180-1186.
18. Sundriyal D, Kumar N, Patnaik I, et al.Terlipressin induced ischaemia of skin[J].BMJ Case Rep, 2013, 2013.Pii:bcr2013010050.doi:10.1136/bcr-2013-010050.
19. Kim HR, Lee YS, Yim HJ, et al.Severe ischemic bowel necrosis caused by terlipressin during treatment of hepatorenal syndrome[J].Clin Mol Hepatol, 2013, 19(4):417-420.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Terlipressin Combined with Somatostatin in Treatment of Hemorrhage of Esophagogastric Varices Due to Portal Hypertension in Liver Cirrhosis

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