食管胃静脉曲张破裂出血行内镜下曲张静脉套扎术和内镜下组织胶注射术的血小板安全阈值： 共识与挑战

贾璐瑶; 聂玉强; 谢飚; 高洪波; 李踔; 黄春明

doi:10.12449/JCH250929

食管胃静脉曲张破裂出血行内镜下曲张静脉套扎术和内镜下组织胶注射术的血小板安全阈值：共识与挑战

DOI: 10.12449/JCH250929

贾璐瑶¹,
聂玉强⁴,
谢飚¹,
高洪波²,
李踔³,
黄春明^1, , ,

1.
广州医科大学附属市八医院消化内科，广州 510440
2.
广州医科大学附属市八医院重症肝病科，广州 510440
3.
广州医科大学附属市八医院神经内科，广州 510440
4.
广州市第一人民医院消化内科，广州 510180

基金项目:

广东省医学科研基金项目 (A2022491)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：贾璐瑶负责文章撰写；聂玉强、谢飚、高洪波、李踔负责文章审核；黄春明负责终审，并最终定稿。

详细信息

通信作者:
黄春明， gz8hhcm@163.com （ORCID： 0009-0009-9272-5802）

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出版历程
- 收稿日期: 2025-01-19
- 录用日期: 2025-02-12
- 出版日期: 2025-09-25

Safe platelet threshold in patients undergoing endoscopic variceal ligation and cyanoacrylate injection due to esophagogastric variceal bleeding： Consensus and challenges

1.
Department of Gastroenterology Guangzhou Eighth People’s Hospital，Guangzhou Medical University Guangzhou 510440 China
2.
Department of Severe Liver Disease Guangzhou Eighth People’sHospital，Guangzhou Medical University Guangzhou 510440 China
3.
Department of Neurology，Guangzhou Eighth People’s Hospital，Guangzhou Medical University Guangzhou 510440 China
4.
Department of Gastroenterology，Guangzhou First People’s Hospital，Guangzhou 510180，China

Research funding:

Medical Research Foundation of Guangdong Province (A2022491)

More Information

Corresponding author: HUANG Chunming， gz8hhcm@163.com （ORCID： 0009-0009-9272-5802）

摘要

摘要: 食管胃静脉曲张破裂出血是晚期肝硬化常见并发症和主要死亡原因，内镜下曲张静脉套扎术和内镜下组织胶注射术是常用治疗策略。血小板减少是肝硬化中最常见的血液学并发症之一，重度血小板减少患者有潜在出血的风险，可能影响临床医生及内镜医生治疗决策。本文总结了内镜下曲张静脉套扎术和内镜下组织胶注射术治疗食管胃静脉曲张在国内外指南建议中的演变及临床研究进展，为临床医生诊疗决策提供依据。
- 食管和胃静脉曲张 /
- 套扎疗法 /
- 化学栓塞，治疗性 /
- 血小板计数
Abstract: Esophagogastric variceal bleeding is a common complication and the leading cause of death in advanced liver cirrhosis， and endoscopic variceal ligation （EVL） and endoscopic cyanoacrylate injection （ECI） are commonly used treatment strategies. Thrombocytopenia is one of the most common hematological complications in liver cirrhosis， and patients with severe thrombocytopenia have the potential risk of bleeding， which may affect treatment decision-making by clinicians and endoscopists. This article reviews the evolution of guidelines and clinical research advances regarding EVL/ECI in China and globally， in order to provide a basis for decision making among clinicians.
- Esophageal and Gastric Varices /
- Cuff Ligating Therapy /
- Chemoembolization， Therapeutic /
- Platelet Count

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表 1 国外EVL血小板阈值指南/共识演变

Table 1. Evolution of guidelines/consensus abroad on platelet threshold before EVL

发布学会	发布时间（年）	出血风险	血小板阈值
美国胃肠内窥镜学会^［5］	2014		不推荐
英国国家健康与护理卓越研究所^［6］	2015		50×10⁹/L
美国肝病学会^［7］	2016
意大利肝病研究学会和意大利内科学会^［8］	2016	中等风险	50×10⁹/L
奥地利胃肠病学和肝病学会以及奥地利介入放射学会^［9］	2017		50×10⁹/L
美国胃肠病学会^［10］	2019	低风险	不需要预防输注血小板，高风险手术采取个体化方法
美国肝病学会^［11］	2020	低风险	建议个体化
美国胃肠病学会^［12］	2020		不纠正
国际血栓与止血学会^［13］	2021	低风险	不纠正
美国胃肠病学会^［14］	2021	低风险	反对检测
欧洲肝病学会^［15］	2022	高风险	不推荐
Baveno协作组^［16］	2022

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