摘要
目的总结肝硬变合并门静脉系统血栓(portal vein thrombosis,PVT)的发生发展概况,同时总结其抗凝治疗现状及展望。方法收集国内外有关治疗肝硬变合并门静脉系统血栓的文献及指南并作综述。结果门静脉系统血栓是肝硬变患者最常见的并发症之一,其发病机制复杂,而肝硬变患者的凝血功能较差,再加上时常合并食管胃底静脉曲张出血(EVB)等严重并发症,往往使临床医生对其治疗方案难以抉择。根据目前研究发现,PVT的形成主要与患者的凝血机制、血管的血流动力学改变及自身因素有关。治疗方法包括:药物治疗、介入治疗和手术治疗。但抗凝治疗肝硬变合并PVT仍存争议,而且在抗凝适应证、药物选择、疗程、安全性监测等方面亦无比较完整的共识。结论肝硬变PVT在一定的适应证下应进行抗凝治疗,但要保证其安全性及有效性,目前仍需要前瞻性大样本随机对照试验来进行研究。
Objective To summarize the occurrence and development of hepatocirrhosis complicated with portal vein thrombosis(PVT),and summarize the status and prospect of anticoagulant treatment.Method The literatures and guidelines on the treatment of hepatocirrhosis complicated with PVT were collected and reviewed.Results PVT was one of the most common complications in patients with hepatocirrhosis.Its pathogenesis was complicated,and the coagulation function of patients with hepatocirrhosis was poor.In addition,patients with severe complications such as esophageal and gastric varicose bleeding(EVB)were often complicated.According to the current study,the formation of PVT was mainly related to the coagulation mechanism of patients,hemorheology changes of blood vessels,and their own factors.Treatment methods included drug therapy,interventional therapy,and surgical treatment.However,there was still controversy on anticoagulant therapy for hepatocirrhosis with PVT,and there was no complete consensus on anticoagulant indications,drug selection,course of treatment,and safety monitoring.Conclusion PVT should be treated with anticoagulant therapy under certain indications,but to ensure its safety and effectiveness,prospective large sample randomized controlled trials are still needed.
作者
王文龙
罗志强
欧阳永鹏
王飞
陈博轩
WANG Wenlong;LUO Zhiqiang;OUYANG Yongpeng;WANG Fei;CHEN Boxuan(Department of Hepatobiliary,Pancreatic,and Splenic Surgery,The Second Affiliated Hospital of Nanchang University,Nanchang 330000,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2020年第3期368-373,共6页
Chinese Journal of Bases and Clinics In General Surgery
关键词
肝硬变
门静脉系统血栓
抗凝治疗
预防
综述
hepatocirrhosis
portal vein thrombosis
anticoagulant therapy
prevention
review
作者简介
通信作者:罗志强,Email:zqluo999@163.com。
