肝硬化门静脉高压脾切除术后门静脉血栓形成的研究进展

敖飞; 陈伟庆

doi:10.3969/j.issn.1001-5256.2018.03.043

肝硬化门静脉高压脾切除术后门静脉血栓形成的研究进展

DOI: 10.3969/j.issn.1001-5256.2018.03.043

敖飞,
陈伟庆

重庆医科大学附属第二医院

详细信息

中图分类号: R657.34
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出版历程
- 收稿日期: 2017-11-06
- 出版日期: 2018-03-20

Research advances in portal vein thrombosis after splenectomy in cirrhotic patients with portal hypertension

The Second Affiliated Hospital of Chongqing Medical University

摘要

摘要: 门静脉血栓形成(PVT)是指门静脉或其分支、脾静脉和肠系膜上静脉内形成的血栓。PVT是门静脉高压症脾切除术后的一种常见并发症,往往可能会导致肝损伤、上消化道出血、肝昏迷,甚至是缺血性肠坏死。因而,早期发现PVT并进行有效干预,对降低PVT患者的病死率有十分重要的意义。对肝硬化脾切除术后PVT危险因素和治疗进行了综述,指出PVT应及早进行有效干预。
- 肝硬化 /
- 高血压,门静脉 /
- 脾切除术 /
- 静脉血栓形成 /
- 综述
Abstract: Portal vein thrombosis ( PVT) refers to the formation of thrombus within the portal vein or its branches, the splenic vein, or the superior mesenteric vein. PVT is a common complication after splenectomy in patients with portal hypertension and may lead to liver injury, upper gastrointestinal bleeding, hepatic coma, and even ischemic intestinal necrosis. Therefore, early identification and effective intervention of PVT play an important role in reducing the mortality of PVT patients. This article reviews the risk factors for PVT after splenectomy in cirrhotic patients and the treatment of PVT and points out that effective intervention should be performed for PVT as early as possible.
- liver cirrhosis /
- hypertension, portal /
- splenectomy /
- venous thrombosis /
- review

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参考文献(47)

[1]DELATOUR HB.III.Thrombosis of the Mesenteric veins as a cause of death after splenectomy[J].Ann Surg, 1895, 21 (1) :24

[2]RATTNER DW, ELLMAN I, WARSHAW AL.Portal vein thrombosis afterelective splenectomy.An underappreciated, potentially lethal syndrome[J].Arch Surg, 1993, 128 (5) :565-569.

[3]ELLISON FC, FABRI PJ.Complications of splenectomy.Etiology, prevention, and management[J].Surg Clin N Am, 1983, 63 (6) :1313-1330.

[4]DELAITRE B, CHAMPAULT G, BARRAT C, et al.Laparoscopic splenectomy for hematologic diseases.Study of 275 cases.French Society of Laparoscopic Surgery[J].Ann Chir, 2000, 125 (6) :522-529.

[5]CHENG Z, YU F, TIAN J, et al.A comparative study of two anti-coagulation plans on the prevention of PVST after laparoscopic splenectomy and esophagogastric devascularization[J].J Thromb Thrombolysis, 2015, 40 (3) :294-301.

[6] WU S, WU Z, ZHANG X, et al.The incidence and risk factors of portal vein system thrombosis after splenectomy and pericardial devascularization[J].Turk J Gastroenterol, 2015, 26 (5) :423-428.

[7]KINJO N, KAWANAKA H, AKAHOSHI T, et al.Risk factors for portal venous thrombosis after splenectomy in patients with cirrhosis and portal hypertension[J].Br J Surg, 2010, 97 (6) :910-916.

[8]ZIRONI G, GAIANI S, FENYVES D, et al.Value of measurement of mean portal flow velocity by Doppler flowmetry in the diagnosis of portal hypertension[J].J Hepatol, 1992, 16 (3) :298-303.

[9]TREBICKA J, STRASSBURG CP.Etiology and complications of portal vein thrombosis[J].Viszeralmedizin, 2014, 30 (6) :375-380.

[10]RAJA K, JACOB M, ASTHANA S.Portal vein thrombosis in cirrhosis[J].J Clin Exp Hepatol, 2014, 4 (4) :320-331.

[11]ABDEL-RAZIK A, MOUSA N, ELHELALY R, et al.De-novo portal vein thrombosis in liver cirrhosis:risk factors and correlation with the Model for End-stage Liver Disease scoring system[J].Eur J Gastroenterol Hepatol, 2015, 27 (5) :585-592.

[12]JIANG GQ, BAI DS, CHEN P, et al.Risk Factors for portal vein system thrombosis after laparoscopic splenectomy in cirrhotic patients with hypersplenism[J].J Laparoendosc Adv Surg Tech A, 2016, 26 (6) :419-423.

[13]QI X, LI H, LIU X, et al.Novel insights into the development of portal vein thrombosis in cirrhosis patients[J].Expert Rev Gastroenterol Hepatol, 2015, 9 (11) :1421-1432.

[14]CHUNG JW, KIM GH, LEE JH, et al.Safety, efficacy and response predictors of anticoagulation for the treatment of nonmalignant portal-vein thrombosis in patients with cirrhosis:a propensity score matching analysis[J].Clin Mol Hepatol, 2014, 20 (4) :384-391.

[15]CALDWELL SH, HOFFMAN M, LISMAN T, et al.Coagulation disorders and hemostasis in liver disease:pathophysiology and critical assessment of current management[J].Hepatology, 2006, 44 (4) :1039-1046.

[16]MONROE DM, HOFFMAN M.The coagulation cascade in cirrhosis[J].Clin Liver Dis, 2009, 13 (1) :1-9.

[17]TRIPODI A, PRIMIGNANI M, LEMMA L, et al.Evidence that low protein C contributes to the procoagulant imbalance in cirrhosis[J].J Hepatol, 2013, 59 (2) :265-270.

[18]TRIPODI A, PRIMIGNANI M, CHANTARANGKUL V, et al.An imbalance of pro-vs anti-coagulation factors in plasma from patients with cirrhosis[J].Gastroenterology, 2009, 137 (6) :2105-2111.

[19]KAWANAKA H, AKAHOSHI T, KINJO N, et al.Impact of antithrombin III concentrates on portal vein thrombosis after splenectomy in patients with liver cirrhosis and hypersplenism[J].Ann Surg, 2010, 251 (1) :76-83.

[20]KAWANAKA H, AKAHOSHI T, ITOH S, et al.Optimizing risk stratification in portal vein thrombosis after splenectomy and its primary prophylaxis with antithrombin III concentrates and danaparoid sodium in liver cirrhosis with portal hypertension[J].J Am Coll Surg, 2014, 219 (5) :865-874.

[21]HE S, HE F.Predictive model of portal venous system thrombosis in cirrhotic portal hypertensive patients after splenectomy[J].Int J Clin Exp Med, 2015, 8 (3) :4236-4242.

[22]WU SL, WU Z, ZHANG XG, et al.The incidence and risk factors of portal vein system thrombosis after splenectomy and pericardial devascularization[J].Turk J Gastroenterol, 2015, 26 (5) :423-428.

[23]LI MX, ZHANG XF, LIU ZW, et al.Risk factors and clinical characteristics of portal vein thrombosis after splenectomy in patients with liver cirrhosis[J].Hepatobiliary Pancreat Dis Int, 2013, 12 (5) :512-519.

[24]GRIESHAMMER M, BANGERTER M, SAUER T, et al.Aetiology and clinical significance of thrombocytosis:analysis of 732 patients with an elevated platelet count[J].J Intern Med, 1999, 245 (3) :295-300.

[25]SENZOLO M, CALDWELL S.Portal vein thrombosis in cirrhosis:ignore, prevent, or treat?[J].Gastroenterology, 2013, 144 (4) :19-20.

[26]SUN L, ZHOU H, GU L, et al.Effects of surgical procedures on the occurrence and development of postoperative portal vein thrombosis in patients with cirrhosis complicated by portal hypertension[J].Int J Surg, 2015, 16 (Pt A) :31-35.

[27]JIANG GQ, XIA BL, CHEN P, et al.Anticoagulation therapy with warfarin versus low-dose aspirin prevents portal vein thrombosis after laparoscopic splenectomy and azygoportal disconnection[J].J Laparoendosc Adv Surg Tech A, 2016, 26 (7) :517-523.

[28]RAY JG, LONN E, YI Q, et al.Venous thromboembolism in association with features of the metabolic syndrome[J].QJM, 2007, 100 (11) :679-684.

[29]TARGARONA EM.Portal vein thrombosis after laparoscopic splenectomy:the size of the risk[J].Surg Innov, 2008, 15 (4) :266-270.

[30]ROMUALDI E, AGENO W.Investigational factor Xa inhibitors for thrombosis and acute coronary syndromes[J].Expert Opin Investig Drugs, 2011, 20 (4) :495-505.

[31]LAI W, LU SC, LI GY, et al.Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization[J].World J Gastroenterol, 2012, 18 (26) :3443-3450.

[32]ZHANG W, ZHOU DM, LI Y.Clinical effect of low-molecularweight heparin in prevention and treatment of liver cirrhosis and portal vein thrombosis after splenectomy:a systematic review and meta-analysis[J].Chin J Hepatol, 2016, 24 (10) :732-737. (in Chinese) 张玮, 周大明, 李阳.低分子肝素防治肝硬化及其脾切除术后门静脉栓塞的系统评价和Meta分析[J].中华肝脏病杂志, 2016, 24 (10) :732-737.

[33]VILLA E, CAMMAC, MARIETTA M, et al.Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis[J].Gastroenterology, 2012, 143 (5) :1253-1260.

[34]BECHMANN LP, SICHAU M, WICHERT M, et al.Low-molecular-weight heparin in patients with advanced cirrhosis[J].Liver Int, 2011, 31 (1) :75-82.

[35]TRIPODI A, MANNUCCI PM.The coagulopathy of chronic liver disease[J].N Engl J Med, 2011, 365 (2) :147-156.

[36]JIANG GQ, BAI DS, CHEN P, et al.Predictors of portal vein system thrombosis after laparoscopic splenectomy and azygoportal disconnection:a retrospective cohort study of 75 consecutive patients with 3-months follow-up[J].Int J Surg, 2016, 30:143-149.

[37]LISMAN T, KAMPHUISEN PW, NORTHUP PG, et al.Established and new-generation antithromboic drugs in patients with cirrhosisdpossibilities and caveats[J].J Hepatol, 2013, 59 (2) :358-366.

[38]LENZ K, DIEPLINGER B, BUDER R, et al.Successful treatment of partial portal vein thrombosis (PVT) with low dose rivaroxaban[J].Z Gastroenterol, 2014, 52 (10) :1175-1177.

[39]YANG H, KIM SR, SONG MJ.Recurrent acute portal vein thrombosis in liver cirrhosis treated by rivaroxaban[J].Clin Mol Hepatol, 2016, 22 (4) :499-502.

[40]POTZE W, ARSHAD F, ADELMEIJER J, et al.Differential in vitro inhibition of thrombin generation by anticoagulant drugs in plasma from patients with cirrhosis[J].PLo S One, 2014, 9 (2) :e88390.

[41]KINJO N, KAWANAKA H, AKAHOSHI T, et al.Portal vein thrombosis in liver cirrhosis[J].World J Hepatol, 2014, 6 (2) :64-71.

[42]SENZOLO M, SARTORI MT, ROSSETTO V, et al.Prospective evaluation of anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis[J].Liver Int, 2012, 32 (6) :919-927.

[43]GABA RC, PARVINIAN A.Transjugular intrahepatic portosystemic shunt for maintenance of portal venous patency in liver transplant candidates[J].J Clin Imaging Sci, 2013, 3:28.

[44]LAKHOO J, GABA RC.Outcomes of transjugular intrahepatic portosystemic shunt creation for flow-enabled dissolution of splenomesenterico-portal venous thrombosis[J].Diagn Interv Imaging, 2016, 97 (11) :1085-1093.

[45]RIGGIO O, RIDOLA L, LUCIDI C, et al.Emerging issues in the use of transjugular intrahepatic portosystemic shunt (TIPS) for management of portal hypertension:time to update the guidelines?[J].Dig Liver Dis, 2010, 42 (7) :462-467.

[46]YANG S, HE C, FAN X, et al.Early prophylactic anticoagulation via transjugular intrahepatic route for portal vein thrombosis after splenectomy in cirrhotic portal hypertension[J].J Vasc Inter Radiol, 2015, 26 (7) :1009-1017.

[47]LIU XR, LIU LX.Updates in the research of portal vein thrombosis in patients with cirrhosis and portal hypertension after splenectomy[J].Chin J Dig Surg, 2015, 14 (2) :170-172. (in Chinese) 刘熙瑞, 刘连新.肝硬化门静脉高压症脾切除术后门静脉血栓形成的研究进展[J].中华消化外科杂志, 2015, 14 (2) :170-172.

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