消化
词汇介绍
拓展阅读
解析
endoscopic [,ɛndəs'kɑpɪk]
释义 adj. 内窥镜的；用内窥镜检查的
例句 Objective: To discuss gastrointestinal polyp typing and endoscopic therapy for "small polyp" . 目的：讨论消化道息肉的分型与“小型息肉”内镜治疗。
variceal [,værɪ'siəl]
释义 adj. （医）静脉曲张的，脉管曲张的
例句 Objective：To analyse the influence of different agents to esophageal variceal bleeding and portal hypertension. 目的：研究不同因素对门脉高压食管胃静脉曲张出血转归的影响。。
ligation [laɪˈɡeɪʃn]
释义 n. 结扎
例句 The rat of portal branch ligation may regard as a model animal of liver regeneration for research. 大鼠门静脉分支结扎可以作为研究肝脏再生动物模型的方法。
概述
概述
内镜下曲张静脉套扎术（endoscopic variceal ligation，EVL）是基于20世纪50年代的痔疮套扎术的技术演变而来的一种安全、有效、简单的食管静脉曲张破裂出血止血和预防出血的治疗方法，EVL后死亡率更少,再出血率更低,根除曲张静脉更快,副作用更少，被认为是应对食管静脉曲张破裂出血的一项重要内镜处置手段。
原理
1）机械中断病变静脉血流，使静脉萎缩，食管局部痉挛；
2）被套扎的静脉内血流停止形成血栓并逐渐机化；
3）静脉管壁形成瘢痕和纤维化；
4）最终曲张静脉退化，达到废除曲张静脉之目的，同时，被套扎的静脉及其表面粘膜缺血坏死，5～7天后组织脱落，局部形成浅溃疡，愈合后留下结缔组织瘢痕，有进一步预防静脉曲张复发的作用。
适应症
食管静脉曲张和（或）胃底静脉曲张破裂出血或药物止血无效者；食管静脉曲张反复出血，全身状况差，不能耐受外科手术治疗者以及择期预防。
禁忌症
心、肺、脑、肾严重功能不全，严重出血，出血性休克未纠正，或全身情况极差，不能配合和耐受者。
操作步骤
1）器械准备：①内镜；②套扎器；③内镜外套管及特制大口垫；
2）病人准备：①前一天患者需进食易消化的流质饮食，避免进食油腻、辛辣食物，术前应禁食6-8小时，禁水4小时；②术前10分钟肌注安定10mg及654-2 10mg或解痉灵20mg；③先常规胃镜检查了解食管、胃、十二指肠情况，避免安装套扎器后视野减少影响观察；
3）操作方法：①留置内镜外套管；②在内镜前端安装套扎器；③套扎曲张静脉。
临床应用
1）传统应用：食管静脉曲张套扎术；胃底静脉曲张套扎术；预防性套扎术；EVL联合其他介入疗法
2）现代应用：针对各类息肉；内镜下黏膜切除术；贲门黏膜撕裂综合征；消化道憩室出血等。
Is there evidence for stopping anticoagulation therapy before endoscopic variceal ligation?
复制标题
内镜下静脉曲张套扎术前是否有停止抗凝治疗的证据？
发表时间：2018-06-22
影响指数：5.5
作者： Maeva Guillaume
期刊：Liver International
The balance of pro-and anticoagulant factors is modified in cirrhosis in addition to qualitative platelet alterations.1,2 Accordingly, both bleeding and thrombotic events can occur during the course of the disease. Anticoagulation therapy (AT) with low molecular weight heparin (LMWH) or Vitamin K antagonists can be indicated in cirrhotics to treat or prevent portal vein thrombosis (PVT)3-5 and other venous thromboembolism (VTE).6 Besides, endoscopic variceal ligation (EVL) is the standard procedure for acute variceal bleeding, for secondary prophylaxis, and an alternative to beta-blockers in primary prophylaxis.4 However, EVL is associated with a risk of bleeding mainly from a post-banding ulcer occurring within 2 weeks after the procedure.7,8 Whether AT could further increase the post-EVL bleeding risk is unknown. Only 1 retrospective study showed that AT does not impact outcome after EVL performed for acute bleeding.9 The benefit-risk balance has not been assessed in the setting of prophylactic EVL. In the context of recent PVT in cirrhotics, because of the lack of dedicated studies, current guidelines recommend that either beta-blockade or EVL should be used before starting AT.3 In cirrhotics without PVT, no recommendations are available about the management of AT during EVL programmes. Thus, some centres choose to delay AT until variceal eradication, or to contraindicate EVL, while others switch long-acting oral anticoagulant agents with short-acting LMWH for a few days around VBL sessions.
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