Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, LE5 4PW, UK.
World J Surg. 2011 Nov;35(11):2510-20. doi: 10.1007/s00268-011-1198-0.
No definitive evidence exists regarding the treatment of acute portal vein thrombosis (PVT). Treatment modalities described include conservative management, anticoagulation, thrombolysis, and thrombectomy. This review examines the impact of such treatment, its outcomes, and the complications resulting from the resultant portal hypertension.
A Medline literature search was undertaken using the keywords portal vein thrombosis, anticoagulation, thrombolysis, and thrombectomy. The primary end point was portal vein recanalization. Secondary outcome measures were morbidity and the development of portal hypertension and its sequelae, including variceal bleeding. Data from articles relating to PVT in the context of cirrhosis, malignancy, or liver transplant were excluded.
Early systemic anticoagulation results in complete portal vein recanalization in 38.3% of cases and partial recanalization in 14.0% of cases. Spontaneous recanalization without treatment can only be expected in up to 16.7% of patients. Frequently this is only when associated with self-limiting underlying pathology and/or minimal thrombus extension. Thrombolysis can be associated with major complications in up to 60% of patients.
The natural history of acute PVT is poorly described. Spontaneous resolution of acute portal vein thrombosis is uncommon. Early anticoagulation results in a satisfactory rate of recanalization with minimal procedure-associated morbidity. Thrombolysis should be used with caution and only considered if the disease is progressive and signs of mesenteric ischemia are present. Further well-designed trials with precise outcome reporting are needed to improve our understanding of the disease.
目前尚无关于急性门静脉血栓（PVT）治疗的明确证据。已描述的治疗方式包括保守治疗、抗凝、溶栓和血栓切除术。本综述检查了这些治疗的影响、结果以及由此导致的门静脉高压症的并发症。
使用“门静脉血栓、抗凝、溶栓和血栓切除术”等关键词对 Medline 文献进行了检索。主要终点是门静脉再通。次要终点是发病率以及门静脉高压症及其后果的发展，包括静脉曲张出血。排除了与肝硬化、恶性肿瘤或肝移植背景下的 PVT 相关的文章中的数据。
早期全身抗凝可使 38.3%的病例完全再通，14.0%的病例部分再通。未经治疗的自发性再通只能在多达 16.7%的患者中预期。通常这仅在与自限性潜在病理和/或最小血栓延伸相关时才会发生。溶栓治疗可能导致多达 60%的患者发生严重并发症。
急性 PVT 的自然史描述不佳。急性门静脉血栓自发消退并不常见。早期抗凝可实现令人满意的再通率，同时伴有最小的手术相关发病率。溶栓应谨慎使用，只有在疾病进展且存在肠系膜缺血迹象时才应考虑使用。需要进一步进行精心设计的试验，并准确报告结果，以提高我们对该疾病的认识。
