肝硬化并门静脉血栓诊疗进展

Progress in Diagnosis and Treatment of Cirrhosis and Portal Vein Thrombosis

肝硬化是我国临床上常见的慢性进行性肝病,其中门静脉血栓(PVT)是其常见的严重并发症之一。随着影像学的发展,PVT的诊断率逐渐升高。目前关于PVT的治疗国内外尚无统一的共识及指南。近年来出现了许多关于肝硬化PVT治疗方面的研究,以抗凝治疗最多见,认为抗凝治疗疗效好且安全性高,可优先考虑;关于溶栓治疗,全身溶栓可导致严重的出血事件,局部溶栓可能具有一定的实用性;介入治疗多为经颈静脉肝内门体分流术,目前建议用于合并门静脉高压或完全闭塞型门静脉血栓患者;而手术治疗多用于各种方式均不能实现门静脉再通且存在危及生命的严重并发症患者以及极少数行肝移植患者,但目前移植后的结局尚不清楚。

Liver cirrhosis is a common chronic progressive liver disease in China,and portal vein thrombosis(PVT)is one of its common serious complications.With the development of imaging,the diagnosis rate of PVT is getting higher and higher.At present,there is no unified consensus and guidelines on the treatment of PVT at home and abroad.In recent years,there have been many studies on the treatment of PVT in liver cirrhosis.Among them,anticoagulation is the most common.Most studies believe that anticoagulation has good efficacy and high safety and can be given priority.Regarding thrombolytic therapy,systemic thrombolysis can lead to serious bleeding events,and local thrombolysis may have shown its practicality.Interventional treatments are mostly intrahepatic portosystemic shunt via jugular vein,and it is currently recommended for the PVT patients combined with portal hypertension or complete occlusion.Surgical treatment is mostly used for patients whose portal vein recanalization cannot be achieved by various methods and there are serious life-threatening complications.There are also very few patients undergoing liver transplantation,but the outcome after transplantation is still unclear.