Department of Radiology, the Third Affiliated Hospital, and Interventional Radiology Institute, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China.
J Vasc Interv Radiol. 2013 Dec;24(12):1808-16. doi: 10.1016/j.jvir.2013.08.018. Epub 2013 Oct 4.
To investigate the treatment and long-term outcome of portal vein thrombosis (PVT) after partial splenic embolization (PSE).
From January 2006 to December 2011, 145 patients with hypersplenism caused by cirrhotic portal hypertension underwent PSE. In 11 cases, PVT was detected 13-42 days after PSE. Among the 11 patients, 5 underwent anticoagulant therapy because of clinical symptoms, and 6 did not receive anticoagulation because they were symptom-free (4 patients) or experienced variceal bleeding (2 patients). The long-term follow-up data from these 11 patients were analyzed retrospectively.
The 11 patients with PVT had a mean splenic infarction ratio of 71.5%. The mean duration of follow-up was 37.6 months. During the follow-up period, none of the 5 patients who underwent anticoagulation developed variceal hemorrhage despite presenting with large esophagogastric varices. Four of the five patients achieved complete resolution of thrombosis, and one did not develop thrombus progression. However, among the 6 patients who did not undergo anticoagulation, 2 developed esophagogastric variceal hemorrhage secondary to thrombus progression, 3 developed cavernous transformation of the portal vein and variceal progression, and 1 had partial calcification of the thrombus. Two patients who had variceal bleeding or rebleeding underwent a transjugular intrahepatic portosystemic shunt. Complete recanalization of the portal vein was achieved after the procedures.
PVT is a severe, potentially fatal complication of PSE. Early detection of PVT and prompt anticoagulation are effective to avoid serious consequences of PVT.
探讨部分性脾栓塞（PSE）后门静脉血栓形成（PVT）的治疗和长期转归。
2006 年 1 月至 2011 年 12 月，145 例肝硬化门静脉高压症所致脾功能亢进患者行 PSE 治疗。PSE 后 13-42 天发现 11 例 PVT。11 例患者中，5 例因临床症状接受抗凝治疗，6 例无症状（4 例）或因食管胃静脉曲张出血（2 例）未接受抗凝治疗。回顾性分析这 11 例患者的长期随访资料。
11 例 PVT 患者脾梗死比例平均为 71.5%。平均随访时间为 37.6 个月。随访期间，5 例抗凝治疗患者尽管存在大的食管胃静脉曲张，但均未发生静脉曲张出血。其中 4 例血栓完全溶解，1 例未发生血栓进展。然而，6 例未抗凝治疗患者中，2 例因血栓进展发生食管胃静脉曲张出血，3 例发生门静脉海绵样变性和静脉曲张进展，1 例血栓部分钙化。2 例有静脉曲张出血或再出血的患者行经颈静脉肝内门体分流术。术后门静脉完全再通。
PVT 是 PSE 的一种严重的、潜在致命的并发症。早期发现 PVT 并及时抗凝治疗可避免 PVT 的严重后果。
