Wanless I R, Wong F, Blendis L M, Greig P, Heathcote E J, Levy G
Department of Pathology, Toronto Hospital, Canada.
Hepatology. 1995 May;21(5):1238-47.
Obliterative lesions in portal veins (PVs) and hepatic veins (HVs) of all sizes are known to occur in cirrhotic livers. PV lesions have generally been attributed to thrombosis, but the pathogenesis of the HV (veno-occlusive) lesions is unknown. We have studied 61 cirrhotic livers removed at transplantation to clarify the prevalence, distribution, and pathogenesis of venous lesions, as well as the association of these lesions with other morphological features and clinical morbidity. Intimal fibrosis that is highly suggestive of healed HV or PV thrombosis was found in at least 70% and 36% of livers, respectively. The distribution of HV lesions was patchy and largely confined to veins between 0.1 and 3 mm in diameter, suggesting multifocal origin in small veins. PV lesions were more uniform throughout the liver, suggesting origin in large veins with propagation to the small veins. HV lesions were associated with regions of confluent fibrosis (focal parenchymal extinction), and PV lesions were associated with regional variation in the size of cirrhotic nodules and a history of bleeding varices. These observations suggest that thrombosis of medium and large PVs and HVs is a frequent occurrence in cirrhosis, and that these events are important in causing progression of cirrhosis.
已知在肝硬化肝脏中会出现各种大小门静脉（PVs）和肝静脉（HVs）的闭塞性病变。PV病变通常归因于血栓形成，但HV（静脉闭塞性）病变的发病机制尚不清楚。我们研究了61例移植时切除的肝硬化肝脏，以阐明静脉病变的患病率、分布和发病机制，以及这些病变与其他形态学特征和临床发病率的关联。分别在至少70%和36%的肝脏中发现了高度提示HV或PV血栓形成已愈合的内膜纤维化。HV病变的分布呈斑片状，主要局限于直径0.1至3毫米的静脉，提示起源于小静脉的多灶性病变。PV病变在整个肝脏中更为均匀，提示起源于大静脉并蔓延至小静脉。HV病变与融合性纤维化区域（局灶性实质消失）相关，PV病变与肝硬化结节大小的区域差异和静脉曲张出血史相关。这些观察结果表明，中大型PV和HV的血栓形成在肝硬化中很常见，并且这些事件在导致肝硬化进展中很重要。
