Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Am J Med. 2010 Feb;123(2):111-9. doi: 10.1016/j.amjmed.2009.05.023.
Portal vein thrombosis is a condition not infrequently encountered by clinicians. It results from a combination of local and systemic prothrombotic risk factors. The presentation of acute thrombosis varies widely from an asymptomatic state to presence of life-threatening intestinal ischemia and infarction. In the chronic stage, patients typically present with variceal bleeding or other complications of portal hypertension. Abdominal ultrasound color Doppler imaging has a 98% negative predictive value, and is considered the imaging modality of choice in diagnosing portal vein thrombosis. Controlled clinical trials to assist with clinical decision-making are lacking in both acute and chronic portal vein thrombosis. Oral anticoagulant therapy is initiated if the risks of bleeding are low, but long-term anticoagulation is generally not recommended in patients with concomitant hepatic cirrhosis. The roles of invasive therapeutic approaches such as thrombolysis and transjugular intrahepatic portosystemic shunt continue to evolve. This review conflates dissenting views into a rational approach of managing patients with portal vein thrombosis for the general internist.
门静脉血栓形成是临床医生经常遇到的一种病症。它是由局部和全身促血栓形成危险因素共同作用引起的。急性血栓形成的表现差异很大，从无症状状态到危及生命的肠缺血和梗死都有。在慢性阶段，患者通常表现为静脉曲张出血或门静脉高压的其他并发症。腹部超声彩色多谱勒成像的阴性预测值为 98%，被认为是诊断门静脉血栓形成的首选影像学检查方法。急性和慢性门静脉血栓形成均缺乏有助于临床决策的对照临床试验。如果出血风险低，则开始口服抗凝治疗，但一般不建议在伴有肝硬化的患者中进行长期抗凝治疗。溶栓和经颈静脉肝内门体分流术等有创治疗方法的作用仍在不断发展。这篇综述将不同的观点融合在一起，为普通内科医生提供了一种合理的门静脉血栓形成患者管理方法。
