肝硬化病人出血的处理...

liver411

[B]Management of Bleeding in the Cirrhotic Patient[/B]

Important advances have been made in the management of variceal (enlarged
veins or arteries) bleeding. Despite these advances, bleeding in the patient
with cirrhosis (liver scarring) remains one of the most demanding clinical
challenges that a gastroenterologist or gastrointestinal surgeon may face.

This article from the Journal of Gastroenterology and Hepatology addresses the
management of bleeding in the patient with cirrhosis.

The aim of management is to identify the source of bleeding, control active
bleeding, and prevent re-bleeding. This requires a multidisciplinary team, and
the optimal management algorithm depends on the clinical circumstance of the
patient and the local availability of endoscopic, radiological, and surgical
expertise.

Injection sclerotherapy is effective in stopping acute variceal bleeding, but
has the drawback of a high incidence of complications.

Endoscopic variceal ligation is just as effective, and is associated with
fewer complications.

To prevent re-bleeding, beta-blockers are recommended for all patients with
large varices (including those which have never bled).

Injection sclerotherapy or band ligation, conducted at weekly intervals after
the initial control of bleeding, is equally effective at obliterating varices
and decreasing the risk of further hemorrhage. Band ligation results in fewer
complications.

Other newer treatment options for variceal bleeding, such as somatostatin
analogs, transjugular intrahepatic portosystemic shunt and liver
transplantation, offer more optimal approaches to control bleeding and prevent
re-bleeding, but may be prohibitively expensive.

Even for the most affluent communities, affordability, cost-effectiveness, and
resource rationing are important considerations in management of patients with
cirrhosis complicated by gastrointestinal bleeding.

05/19/03

Reference
S Chung. Journal of Gastroenterology and Hepatology 17(4): 355-360. April
2002.