肝硬化并发门静脉血栓防治研究进展

门静脉血栓（PVT）是肝硬化的常见并发症,也是患者预后不良的临床标志之一。肝硬化常并发食管胃底静脉曲张、凝血酶原时间延长和血小板降低,存在门脉高压所致出血的风险。临床上,对应用抗凝药物防治PVT存在较多的疑虑。目前,防治肝硬化并发PVT仍缺乏可以遵循的诊疗指南。然而,日益增加的证据显示,抗凝治疗不仅不会增加肝硬化患者出血的风险,而且可获得较高的血管再通率。预防性抗凝治疗可有效降低肝硬化患者PVT发病率,并可能改善肝硬化疾病进程。如抗凝治疗无效,经颈静脉肝内门体静脉支架分流术（TIPS）或溶栓治疗可作为肝硬化并发PVT的备选处理方案。TIPS可获较高的血管再通率,但技术难度较大,而溶栓治疗存在出血风险,需谨慎进行。

Prophylaxis and management of patients with portal vein thrombosis complicting liver cirrhosis

Portal vein thrombosis （PVT） is a common complications in patients with liver cirrhosis,often as a predictor of poor prognosis. There is a controversial veiws about anticoagulation treatment in dealting with PVT as the high risk of hemorrhage in this settints. There is no at present guidelines related in this field. However,there are increasing evidence showing that anticoagulant therapy offers a high recanalization in patients with PVT,without an increase of gastrointestinal bleeding risks. The application of anticoagulation decreases the morbidity in patients with PVT and might improve the liver functions. Moreover,the earlier the anticoagulation started,the higher the rate of recanalization the patients could obtain. Thus,cirrhosis patients are recommended to start the anticoagulation after a definite diagnosis of PVT as soon as possible. If the anticoagulation therapy does not work,the transjugular intrahepatic portosystem shunt（TIPS） or thrombolysis are alternative strategy for patients with liver cirrhosis. The patients might acquire a high rate of vascular recanalization after TIPS,while this technique is very complicate. The thrombolysis should be taken carefully because of a high risk of bleeding.