Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Semin Fetal Neonatal Med. 2011 Dec;16(6):329-39. doi: 10.1016/j.siny.2011.08.005. Epub 2011 Sep 16.
Neonatal portal vein thrombosis (PVT) is an increasingly recognized event. Patients are generally asymptomatic in the neonatal period. The diagnosis is made with Doppler ultrasound. Umbilical catheterization, exchange transfusion and sepsis are risk factors for neonatal PVT. Thrombophilia is possibly a contributing risk factor. Although there are potential serious acute complications such as hepatic necrosis, the outcome is good in the majority of cases, followed up to 8 years of age. Thrombus resolution occurs in 30-70% in days to months. Liver lobe atrophy may occur following PVT, and does not appear to be associated with any impairment of liver function. Non-occlusive thrombosis is more likely to resolve than non-occlusive thrombosis. A subset of patients without resolution is at risk for developing portal hypertension over the next decade of life. There are no current defining features present during the neonatal period to enable identification of neonates at risk for portal hypertension. There is no evidence that anticoagulation therapy improves time to resolution or decreases the likelihood of portal hypertension. Anticoagulation therapy may be considered. A management algorithm is proposed.
新生儿门静脉血栓形成（PVT）是一种日益被认识到的疾病。患儿在新生儿期通常无症状。诊断依靠多普勒超声。脐静脉置管、换血和败血症是新生儿 PVT 的危险因素。血栓形成倾向可能是一个促成危险因素。尽管存在潜在的严重急性并发症，如肝坏死，但在大多数情况下，随访至 8 岁时结局良好。血栓在数天至数月内溶解的比例为 30-70%。PVT 后可能发生肝叶萎缩，但似乎与肝功能损害无关。非闭塞性血栓比非闭塞性血栓更有可能溶解。在未来十年的生命中，有一部分未溶解的患者有发生门静脉高压的风险。在新生儿期目前没有任何特征可以确定有发生门静脉高压风险的新生儿。没有证据表明抗凝治疗能改善溶解时间或降低门静脉高压的可能性。抗凝治疗可考虑。提出了一种管理算法。
