Condat B, Pessione F, Helene Denninger M, Hillaire S, Valla D
Service d'hépatologie et INSERM U481, Fédération médico-chirurgicale d'hépato-gastroentérologie, Assistance Publique-Hôpitaux de Paris, France.
Hepatology. 2000 Sep;32(3):466-70. doi: 10.1053/jhep.2000.16597.
Characteristics and outcomes of recent portal or mesenteric venous thrombosis are ill-known. We intended to compare these features with those of patients with portal cavernoma, and also to assess the incidence of recanalization of recent thrombosis on anticoagulation therapy. All patients seen between 1983 and 1999 were enrolled into this retrospective study if recent portal or mesenteric venous thrombosis or portal cavernoma had been documented, and if cancer of the liver, pancreas, or bile duct, intrahepatic block including cirrhosis, and obstruction of the hepatic veins had been ruled out. The proportion of recent thrombosis was 7% in patients seen before 1990 and 56% after 1994 (P <.05). Patients with recent thrombosis (n = 33) or cavernoma (n = 108) did not differ with regard to age, sex ratio, or prevalence of prothrombotic states and of previous thrombotic events. In patients with recent thrombosis, septic pylephlebitis was more common and the incidence of gastrointestinal bleeding was lower (2.4 vs. 12.7/100 patient-years). Recanalization occurred in 25 of 27 patients given anticoagulation and 0 of 2 patients not given anticoagulation. The probability of recanalization was related to the extent of thrombosis (P =.003). In conclusion, mesenteric or portal venous thrombosis is increasingly recognized at an early stage. The features differentiating recent thrombosis and cavernoma are related to silent onset precluding early recognition and therapy in the latter. Frequent association with prothrombotic states and frequent recanalization on anticoagulation support the recommendation of early anticoagulation therapy in all patients with recent portal vein thrombosis.
近期门静脉或肠系膜静脉血栓形成的特征和转归鲜为人知。我们旨在将这些特征与门静脉海绵样变性患者的特征进行比较，并评估近期血栓形成患者接受抗凝治疗后的再通发生率。如果记录到近期门静脉或肠系膜静脉血栓形成或门静脉海绵样变性，且排除了肝、胰腺或胆管癌、包括肝硬化在内的肝内阻塞以及肝静脉阻塞，则将1983年至1999年间就诊的所有患者纳入这项回顾性研究。1990年前就诊患者中近期血栓形成的比例为7%，1994年后为56%（P<0.05）。近期血栓形成患者（n = 33）或海绵样变性患者（n = 108）在年龄、性别比例、血栓形成前状态和既往血栓形成事件的患病率方面无差异。在近期血栓形成患者中，化脓性门静脉炎更常见，胃肠道出血的发生率较低（2.4 vs. 12.7/100患者年）。接受抗凝治疗的27例患者中有25例发生再通，未接受抗凝治疗的2例患者均未发生再通。再通的可能性与血栓形成的程度有关（P = 0.003）。总之，肠系膜或门静脉血栓形成在早期越来越多地被认识到。区分近期血栓形成和海绵样变性的特征与后者隐匿性起病有关，从而妨碍早期识别和治疗。与血栓形成前状态的频繁关联以及抗凝治疗后频繁再通支持对所有近期门静脉血栓形成患者尽早进行抗凝治疗的建议。
