:C : (2009) GOV 3. GOV. (gastroesophageal varices, GOV) ( a,c) :72 h

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1 152 J Intern Med Concepts Pract 2009 Vol.4 No.2 (2008 ) :R575.2; R571.3 :C : (2009) GOV 1. GOV : 48 h GOV (ac) () () [1] (gastroesophageal varices GOV) (ac) GOV 2. GOV :72 h 16 h 4 [ <70 mm Hg (1 mm Hg=0.133 kpa) > 100 /min >20 /min]; 2 GOV >20 mm Hg >20 /min ;3 GOV 30 g/l 3. GOV : ( ; >20 mm Hg >20 /min; >30 g/l) : 72 h~6 : ( GOV () 1) 1 GOV GOV 1 GOV ;2 GOV ( ) ( );3 a b 3 (ac) [2] (G1): (G2): (G3): ( ) A B C GOV 3 1 (GOV1) GOV 2~5 cm 2 (GOV2) 3 (GOV3) [3]

2 (IGV) 2 1 (IGV1) 2 (IGV2) IGV1 (ac) GOV GOV ) (B); (HVPG) GOV 2~3 1 (C); HVPG 3~5 mm Hg HVPG< 10 mm Hg GOV 1 (C) HVPG 10~12 mm Hg HVPG<12 mm Hg [56] GOV 50% (Child-Pugh B C 40%Child-Pugh A 85%C (PBC) (ac) β (B) 16% β 1~2 8% 1 (C) HVPG>10 mm Hg 8% (Child-Pugh B C ) (Child-Pugh B/C ) β [7] (EVL) [8] 5%~15% Pugh A ) β β 6 20% EVL 24 h HVPG>20 mm Hg 1 (EIS) 83%1 64%; 29%20% 1. β : 60% 1~ 10 mg 2 /d ; 2 :HVPG 12 mm Hg >20% HVPG 75% 50~60 /min : HVPG HVPG HVPG<12 mm Hg Child-Pugh C : HVPG >20% HVPG 12 mm Hg 2. : ( ) 20%( HVPG ) [ (3 /d 10 mg/ 80 mg/d) 5- (2 /d 10 mg/ 33.0%~ 80 mg/d)] 72.4% 2 5- EVL 25% Child-Pugh GOV GOV - β (β 1~2 1 ; [4] β ) β (A) (Child- 20 mg 1 /d

3 154 J Intern Med Concepts Pract 2009 Vol.4 No.2 3. β : 8 (vapreotide) β 4. : HVPG [12] 250 μg 250 μg/h 8 [1314] 50 μg 50 μg/h [910] 85%~90% 5 d ( ) 50 μg 50 μg/h 3H 2 :H 2 ph 4 : 1. : (B) 80 g/l 3. (B): [5] (B) [16] :1 90~120 mm Hg;2 <100 /min;3 >40 ml/h 2. : 4. : [11] (B)β 1 : [7] ( EVL ( ) ) (A) [18] 1. EVL :1 : ; 24 h ; 0.2~0.4 U/min 0.8 U/min; >90 mm Hg [15] 8~24 h 1 24 h Na + <140 mmol/l;4 [17] 24 h ( ); ( ) 2 : ; ; HVPG 3 : 10~14 d 2 2 mg/4 h 1 2 /d 1 mg/ 5 d ; 6~ 2 (A):

4 : 24 h 90%~99% ( 1 ) ( ) ( ) 6~12 1 : 2. EIS:1 :EVL EVL ( ) ; EIS 2 : ; ; ; ; : Child-Pugh C 3 :1 EIS 2 3 TIPS; EIS 2 : 1 1 3~5 EIS 1 TIPS ~12 : ( ) 4 ; ; : 6~8 h ; ; ; ; ; ( ); 2. : EIS (BORTO) EIS : (PTVE) ; 3. :1 : ; 20% ( ) 24 h HVPG>20 mm Hg 2 : ( 24 h ) Child-Pugh A [19] ;Child-Pugh B 3 ;Child-Pugh C ( :EIS 5~7 d 50%) [20] 2 EVL EIS GOV [21-23] ( ) GOV (β ) [2425] EVL EIS EVLEIS [26] EVL (B) 1~2 60% 33% [4] ( ) [1927] (B) β EVL EIS (A) 1. - (TIPS): ( ) TIPS β EVL EIS [30] (A) GOV (C) - TIPS 1 [2] ( ) 1. β : β [2829] [31] TIPS β

5 156 J Intern Med Concepts Pract 2009 Vol.4 No.2 EVL [32] Child-Pugh A B ( ) Child-Pugh C 5-2. : Child-Pugh A HVPG [33] 3 Child-Pugh A B - ( 3 ) : / : 5- / / : 5- / / 10 5 GOV β HVPG GOV 1 β EVL 2007 (EASL) Fibroscan (LS) TIPS 6 85%~90% 1 70%~85%2 45%~70% GOV TIPS 1~2 ( 18 ) 5~10 TIPS (PTFE) GOV 1 TIPS TIPS Child- : Pugh A B ( ): PTVE GOV PTVE [34] BORTO [3536] 60%~ : ( TIPS) HVPG GOV 90% 50%~80% :

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