肝硬化并PVT的治疗

Treatment of Liver Cirrhosis with PVT

摘要: 门静脉血栓(PVT)是肝硬化的常见并发症之一(在肝硬化患者中的发生率为0.6%~26%)，是指发生于门静脉主干、肠系膜上静脉、肠系膜下静脉或脾静脉的血栓，PVT起病较为隐匿，可导致不良结局，包括消化道出血、肝功能持续恶化、肠道坏死等。PVT的早期诊断及治疗可提高患者的生存率及生活质量，但目前暂无有效指标可提示患者早期PVT的发生，PVT的治疗国内外也暂无统一的指南。目前大多数研究表明肝硬化PVT患者早期抗凝治疗可显著提高门静脉血栓再通率。虽然PVT早期抗凝已达成共识，但具体的抗凝时机、抗凝药物的选择目前还无统一共识。本文就近年来PVT诊断及治疗方面取得的进展进行简要综述，以期为PVT患者的临床诊断及治疗提供理论参考。

Abstract: Portal vein thrombosis (PVT) is one of the common complications of cirrhosis (incidence 0.6%~26% in cirrhotic patients) and refers to thrombi that occur in the main portal vein trunk, superior mesenteric vein, inferior mesenteric vein, or splenic vein, and PVT has a more insidious onset and can lead to adverse outcomes, including gastrointestinal bleeding, persistent deterioration of liver function, and intestinal necrosis, etc. The early diagnosis and treatment of PVT can improve the survival rate and quality of life of patients, but there are currently no effective indicators to suggest the occurrence of early PVT in patients, and the treatment of PVT has no uniform guidelines at home and abroad. Most of the current studies have shown that early anticoagulation in cirrhotic patients with PVT significantly increases the rate of portal vein thrombus recanalization. Although there is a consensus on early anticoagulation in PVT, there is currently no consensus on the specific timing of anticoagulation, the choice of anticoagulant. In this review, we briefly summarize the recent progress in the diagnosis and treatment of PVT, with the aim of providing a theoretical reference for the clinical diagnosis and treatment of patients with PVT.