Non-tumoral PVT is the most common thrombotic event in patients with cirrhosis, with an annual incidence of up to 12%[127,128]. 非肿瘤性PVT是肝硬化患者中最常见的血栓性事件，每年的发病率高达12%的[127,128]。 Asymptomatic presentation is common with incidental diagnosis during routine surveillance or pretransplant workup. 在常规监测或移植前检查中，无症状表现与偶然诊断中很常见。 PVT has a significant but variable influence on the outcome of patients with cirrhosis. PVT对肝硬化患者的预后有显著但可变的影响。 Multiple studies have found that in the natural history of cirrhosis and PVT, 40%-70% of patients will have a progression of thrombus leading to complete occlusion of portal vein or extension to other splanchnic vessels[129-131]. 多项研究发现，在肝硬化和PVT的自然病史中，40%-70%的患者会出现血栓进展，导致门静脉完全闭塞或延伸到其他内脏血管[129-131]。 While anticoagulation is considered to be the mainstay of therapy in PVT in the absence of cirrhosis, optimal management of PVT in cirrhosis has not been addressed adequately in clinical guidelines. 虽然抗凝被认为是无肝硬化的PVT的主要治疗方法，但肝硬化的PVT的最佳治疗在临床指南中尚未得到充分的解决。 In a prospective study on the role of anticoagulation and TIPS in 56 patients from Europe, only 36% of patients on anticoagulation showed complete recanalization, while 27% of patients showed partial recanalization[130]. 在一项关于56例欧洲患者抗凝和TIPS作用的前瞻性研究中，只有36%的抗凝患者显示完全再通，而27%的患者显示部分再通[130]。 The presence of ascites and splenic vein thrombosis were independently associated with the failure of anticoagulation therapy. 腹水和脾静脉血栓形成的存在与抗凝治疗的失败独立相关。 Previously considered a contraindication for TIPS, multiple case reports, and few case series have described the successful placement of TIPS in patients with cirrhosis with PVT with acute VH, and RA[132-135]. 以前被认为是TIPS的禁忌症，多病例报告，少数病例系列描述了TIPS成功放置于肝硬化PVT伴急性VH和RA的患者[132-135]。 Besides, recently two RCTs comparing TIPS with EBL plus propranolol in patients with PVT showed that TIPS was more effective than medical and endoscopic therapy without an increase in the risk of HE in the vast majority of patients leading to a recanalization rate of 95%[28,29]. 此外，最近两项比较TIPS与EBL+普萘洛尔治疗PVT患者的随机对照试验显示，TIPS比药物和内镜治疗更有效，而绝大多数患者的风险导致[28,29]再通率为95%。 Studies had also shown that even when persistent thrombus on completion splenoportogram was not stented (to preserve the long length of the unstented portal vein for liver transplant) and TIPS was not followed by anticoagulation or thrombolytic therapy, recanalization was frequently observed, implying that PVT in these patients is mainly due to hemodynamic factors[133]. 研究还表明，即使脾门静脉影像持续性血栓没有支架（为了保持未支架门静脉长度以备肝移植）和TIPS没有抗凝或溶栓治疗，可以经常观察到再通，这意味着这些患者PVT主要是由于血流动力学因素[133]。 With the advent of multiple imaging techniques for real-time visualization of the portal vein during TIPS, PVT is no longer considered as an absolute contraindication to TIPS placement. 随着多种门静脉实时可视化成像技术的出现，PVT不再被认为是TIPS放置的绝对禁忌症。 Also, portal vein thrombolysis and balloon angioplasty via recently described percutaneous transhepatic and transsplenic routes allow better visualization of the portal vein before transjugular puncture, resulting in markedly improved outcomes[133,136]. 此外，通过最近描述的经皮经脾和经脾途径进行的门静脉溶栓和球囊血管成形术，可以在经颈穿刺前更好地显示门静脉，从而显著改善预后[133,136]。 |