Berney T, Morales M, Broquet P E, Mentha G, Morel P
Clinic of Digestive Surgery, Geneva University Hospital, Switzerland.
Hepatogastroenterology. 1998 Nov-Dec;45(24):2275-81.
BACKGROUND/AIMS: This study analyzes risk factors that influence the course and outcome of portal and superior mesenteric vein thrombosis (PMVT).
We retrospectively reviewed 45 patients who were admitted to our institution over a 17-year period with a diagnosis of PMVT. Patients were classified according to three etiological groups, namely: cirrhosis (47%), pancreatitis (22%), and other causes (33%), with 1 patient belonging to two different groups.
Over the course of the disease, rupture of gastric or esophageal varices was more frequent (p<0.005) in cirrhotics (75%) than non-cirrhotics (17%). Sclerotherapy was always the first treatment for variceal bleeding, with a success rate of 73% but a rate of recurrence of 56%. Surgical procedures were performed on 22% of patients. Actuarial survival was 43% at 5 years, but survival was significantly increased for idiopathic cases (p=0.005) and decreased in the presence of cirrhosis (p<0.001), malignancy (p<0.0001) or hematemesis (p<0.005). Gastrointestinal bleeding and terminal malignancies were responsible for 50% of deaths.
Cirrhotic patients experience a detrimental outcome with an increased risk of gastrointestinal bleeding, which is the first cause of mortality in PMVT. Non-cirrhotic patients, especially idiopathic cases, enjoy a longer survival rate and seldom bleed, which allows for the use of anticoagulative therapy.
背景/目的：本研究分析影响门静脉和肠系膜上静脉血栓形成（PMVT）病程及结局的危险因素。
我们回顾性分析了17年间收治于我院的45例诊断为PMVT的患者。患者根据三种病因分组，即：肝硬化（47%）、胰腺炎（22%）和其他病因（33%），有1例患者属于两个不同组。
在疾病过程中，肝硬化患者（75%）胃或食管静脉曲张破裂比非肝硬化患者（17%）更常见（p<0.005）。硬化疗法始终是静脉曲张出血的首选治疗方法，成功率为73%，但复发率为56%。22%的患者接受了外科手术。5年精算生存率为43%，但特发性病例的生存率显著提高（p=0.005），而存在肝硬化（p<0.001）、恶性肿瘤（p<0.0001）或呕血（p<0.005）时生存率降低。胃肠道出血和终末期恶性肿瘤导致了50%的死亡。
肝硬化患者预后不良，胃肠道出血风险增加，这是PMVT死亡的首要原因。非肝硬化患者，尤其是特发性病例，生存率较长且很少出血，这使得抗凝治疗得以应用。
