Wang Jian, Chai Jia-Sui, Zhang Ya-Min
Hepatobiliary Surgery Department, Tianjin First Center Hospital, Tianjin Clinical Research Center for Organ Transplantation, Key Laboratory of Transplant Medicine, Chinese Academy of Medical Sciences First Central Clinic of Tianjin Medical University, Nankai District, Tianjin, China.
Medicine (Baltimore). 2018 Jun;97(26):e11183. doi: 10.1097/MD.0000000000011183.
Portal vein thrombosis (PVT) is relatively common in patients with liver cirrhosis waiting for liver transplantation (LT). Anticoagulation is an important non-invasive treatment strategy for patients with cirrhosis and PVT.
This is the case of a 51-year-old man who presented with cryptogenic liver cirrhosis associated with ascites. Computed tomography (CT) and Doppler ultrasonography (US) showed a partially obstructive thrombus of the portal vein (Yerdel Grade II).
Portal vein thrombosis (Yerdel Grade II); liver cirrhosis.
The PVT was completely recanalized after 4 months of treatment with the low molecular weight heparin (LMWH) medication enoxaparin but discontinuation of anticoagulants led to PVT recurrence. The patient's condition deteriorated, even though re-treating the anticoagulation with enoxaparin significantly reduced the PVT.
The thrombus was removed by a thrombectomy and LT was performed successfully without any vascular complications.
Patients with cirrhosis and PVT who are waiting LT can be effectively treated with LMWH anticoagulants. Careful use of anticoagulation is generally safe. Early initiation of anticoagulation treatment may be associated with a high rate of portal vein recanalization.
门静脉血栓形成（PVT）在等待肝移植（LT）的肝硬化患者中相对常见。抗凝是肝硬化合并PVT患者重要的非侵入性治疗策略。
这是一名51岁男性患者，表现为隐源性肝硬化伴腹水。计算机断层扫描（CT）和多普勒超声检查（US）显示门静脉存在部分阻塞性血栓（耶德尔二级）。
门静脉血栓形成（耶德尔二级）；肝硬化。
使用低分子肝素（LMWH）药物依诺肝素治疗4个月后，PVT完全再通，但停用抗凝剂导致PVT复发。尽管再次使用依诺肝素进行抗凝治疗可显著减轻PVT，但患者病情仍恶化。
通过血栓切除术清除血栓，成功进行了肝移植，未出现任何血管并发症。
等待肝移植的肝硬化合并PVT患者可使用LMWH抗凝剂进行有效治疗。谨慎使用抗凝剂通常是安全的。早期开始抗凝治疗可能与门静脉再通率高有关。
