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中华移植杂志(电子版)

中华移植杂志(电子版) ›› 2019, Vol. 13 ›› Issue (03) : 245 -251. doi: 10.3877/cma.j.issn.1674-3903.2019.03.019

所属专题： 文献；

综述

门静脉血栓与肝移植
罗方舟1, 杨喆1, 郑树森2,†()   
  1. 1. 310003　杭州，浙江大学医学院附属第一医院肝胆胰外科
    2. 310003　杭州，浙江大学医学院附属第一医院肝胆胰外科；310015　杭州，浙江树人大学树兰国际医学院
  • 收稿日期:2019-03-29 出版日期:2019-08-25
  • 通信作者: 郑树森
  • 基金资助:
    国家自然科学基金创新群体(81421062)

Portal vein thrombosis and liver transplantation

Fangzhou Luo1, Zhe Yang1, Shusen Zheng2,†()   

  1. 1. Department of Hepatopancreatobiliary Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
    2. Department of Hepatopancreatobiliary Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; Shulan International Medical College of Zhejiang Shuren University, Hangzhou 310015, China
  • Received:2019-03-29 Published:2019-08-25
  • Corresponding author: Shusen Zheng
  • About author:
    Corresponding author: Zheng Shusen, Email:
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引用本文：

罗方舟, 杨喆, 郑树森. 门静脉血栓与肝移植[J]. 中华移植杂志(电子版), 2019, 13(03): 245-251.

Fangzhou Luo, Zhe Yang, Shusen Zheng. Portal vein thrombosis and liver transplantation[J]. Chinese Journal of Transplantation(Electronic Edition), 2019, 13(03): 245-251.

门静脉血栓形成(PVT)是指门静脉主干以及门静脉属支内血栓形成。由于PVT常缺乏特征性表现，主要依赖于术前影像学检查发现，甚至在术中偶然发现PVT。随着我国肝移植事业的不断发展，移植过程中发现PVT的案例越来越多，PVT已不再是肝移植禁忌证。因此，针对PVT的诊断、治疗以及移植过程中的处理方法显得尤为重要。本文根据国内外最新研究进展及经典文献报道，对肝移植中PVT展开综述。

关键词: 肝移植, 门静脉血栓形成, 诊断, 分型, 门静脉重建

Portal vein thrombosis (PVT) is defined as thrombosis in main portal vein and its tributary. Because of lacking specific clinical characteristics, most PVT was detected through imageological examination before transplantation, or discovered by accident during surgery. With rapid development of liver transplantation in China, more liver transplantation recipients with PVT were found during transplantation, and PVT is no longer the contraindication of liver transplantation. Therefore, reasonable diagnosis and treatment, and effective management during transplantation aiming at PVT is important. This review will elucidate the recent domestic and international progress in the aspect of PVT in liver transplantation.

Key words: Liver transplantation, Portal vein thrombosis, Diagnosis, Classification, Reconstruction of portal vein
表1 门静脉血栓形成分级
文献 Ⅰ级 Ⅱ级 Ⅲ级 Ⅵ级
Yerdel等[2] 门静脉阻塞程度<50%，远端肠系膜上静脉通畅 门静脉阻塞程度>50%，远端肠系膜上静脉通畅 门静脉完全栓塞，肠系膜近端血栓栓塞，肠系膜静脉远端尚通畅 门静脉主干和肠系膜上静脉管腔完全栓塞
Stieber等[21] 血栓仅限于门静脉主干，无论阻塞程度 血栓蔓延至肠系膜上静脉，脾静脉尚通畅 门静脉完全栓塞且血栓蔓延至脾静脉和肠系膜上静脉通畅 门静脉、脾静脉和肠系膜上静脉均完全栓塞
Kim等[22] PVT位于肠系膜上静脉与脾静脉汇合点上 PVT蔓延至肠系膜上静脉与脾静脉汇合点下，远端肠系膜上静脉尚通畅 PVT蔓延至远端肠系膜上静脉，伴冠状静脉侧支形成 门静脉主干、肠系膜上静脉和脾静脉完全血栓栓塞，冠状静脉血栓形成
Bauer等[23] 门静脉阻塞程度≤25% 门静脉阻塞程度26%～50% 门静脉阻塞程度51%～75% 门静脉阻塞程度>75%
Charco等[24] 血栓仅限于门静脉(包括部分与完全阻塞) 血栓蔓延至肠系膜上静脉近端，可再通 弥漫性血栓形成伴侧支循环扩张 弥漫性血栓形成，不伴侧支循环扩张
Jamieson等[25] 血栓仅限于门静脉与肠系膜汇合处上，无论阻塞程度 血栓蔓延至肠系膜上静脉内，但肠系膜上静脉尚通畅 弥漫性血栓形成，但具有较大的侧支循环 弥漫性血栓形成，伴纤细的侧支循环
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