Nakanuma Y, Ohta G, Kurumaya H, Tanino M, Doishita K, Takayanagi N, Rin S
Am J Gastroenterol. 1984 Oct;79(10):782-9.
Seven adult autopsied cases with noncirrhotic portal hypertension and thromboembolic occlusion of the large extra- and intrahepatic portal veins are presented. There were two types of portal venous occlusion: old thromboembolic occlusion (group A, two cases) and fresh thromboembolic occlusion (group B, five cases). In group A the occlusion was complete and the affected veins, which were identified clearly by elastic fiber stains, were characteristically shrunk to cause a long-standing portal hypertension. Extra- and intrahepatic collaterals were prominent. In group B the extra- and, sometimes, intrahepatic larger portal veins with fresh thromboemboli revealed variable degrees of phlebosclerosis, probably resulting from organization of repeated portal venous thromboemboli. These sclerotic changes further extended into the medium-sized and smaller intrahepatic portal veins. The latter and other hepatic morphology resembled those of idiopathic portal hypertension without larger portal venous occlusion (group C). Thus, in group B the widespread involvement of the portal venous system by thromboembolic events, particularly the smaller ones, might be important not only for the development of portal hypertension but also for understanding the hepatic pathology of idiopathic portal hypertension.
本文报告了7例非肝硬化性门静脉高压且肝内外大门静脉血栓栓塞性闭塞的成人尸检病例。门静脉闭塞有两种类型：陈旧性血栓栓塞性闭塞（A组，2例）和新鲜血栓栓塞性闭塞（B组，5例）。A组闭塞完全，通过弹性纤维染色可清晰识别的受累静脉特征性地收缩，导致长期门静脉高压。肝内外侧支循环明显。B组有新鲜血栓栓子的肝内外较大门静脉显示出不同程度的静脉硬化，可能是反复门静脉血栓栓塞机化所致。这些硬化改变进一步延伸至肝内中小门静脉。后者及其他肝脏形态与无较大门静脉闭塞的特发性门静脉高压（C组）相似。因此，在B组中，血栓栓塞事件尤其是较小的血栓栓塞事件对门静脉系统的广泛累及，可能不仅对门静脉高压的发生很重要，而且对理解特发性门静脉高压的肝脏病理也很重要。
