Variceal bleeding in cirrhosis is one of the most challenging problems in gastroenterology. Bleeding from gastro-oesophageal varices is a main cause of early death (approximately 30%-50% at the first bleeding) in cirrhosis. The aim of our therapy is to locate the place of bleeding, control active bleeding and prevent rebleeding, but it is difficult sometimes. A number of treatment strategies, such as somatostain analogs, vasopressin, endoscopic therapy, transjugular intrahepatic portasystemic shunt (TIPS) have evolved over time, but which is better? New evidence of therapy for variceal haemorrhage will be introduced in Cirrhosis that includes: 1.Somatostatin, vasopressin, ligation, schlerotherapy and balloon tamponade for acute variceal bleeding; 2.β-blockers, ligation, schlerotherapy and shunt surgery for prophylaxis of primary variceal bleeding; 3.β-blockers, ligation, schlerotherapy, shunt surgery and TIPS for prophylaxis of variceal rebleeding; 4. Antibiotic prophylaxis for cirrhosis with gastrointestinal bleeding.
ObjectiveTo evaluate the operative technique and clinical efficacy of laparoscopic splenectomy (LS) combined with esophagogastric devascularization in treatment of portal hypertension induced by liver cirrhosis. MethodsTwelve cases with esophageal and gastric varices induced by portal hypertension and liver cirrhosis were treated by the LS combined with esophagogastric devascularization in our department from March 2009 to August 2010, which clinical data were analyzed and summarized retrospectively. ResultsThe splenic artery was ligated before the treatment of splenic pedicle in 12 cases, LS combined with pericardial devascularization was successfully performed in 10 cases, 7 cases of which were treated by the level two transection method of splenic pedicle, and 2 cases were converted to open surgery due to intraoperative bleeding. In 10 cases, the operative time was 180-300 min (average 210 min), and intraoperative blood loss was 200-1 000 ml (average 480 ml). The postoperative hospital stay was 8-15 d (average 9 d)， the postoperative complications included plural effusion （lt;300 ml） in 2 cases， mild ascites （lt;300 ml） in 2 cases, and mild pancreatic leakage in 1 case， but all were cured eventually， and no mortality occurred. Followup was conducted in 12 patients for 4 to 20 months (average 7 months), and no rebleeding occurred. ConclusionsLS combined with pericardial devascularization is relatively safe and effective methods in treatment of portal hypertension induced by liver cirrhosis. The keys to success include ligation of splenic artery, and the use of harmonic scalpel combined with ligasure to treat splenic pedicle.
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。
Transjugular intrahepatic portosystemic shunt (TIPS) has been used in the treatment of cirrhotic portal hypertension for more than 30 years. With the development of stent technology and clinical practice technology, TIPS is becoming more and more perfect in the treatment of portal hypertension. From the single-use of bare stent in the past to the application of bare stent combined with coated stent or particular Viatorr stent, the patency of stent has been significantly improved. In addition, the selection of stent caliber and the puncture part of shunt gradually reduces the occurrence of hepatic encephalopathy, liver failure and other complications caused by excessive shunt. TIPS technology has the advantages of minimally invasive, safe and reducing portal vein pressure. It has gradually become one of the primary surgical methods in the treatment of portal hypertension, esophagogastric variceal bleeding, intractable ascites, and so on.