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Тромбоза на порталната вена - клинични случаи и подходи в лечението в условията на медицинската практика

И. Василевски, В. Михайлов, И. Tакоров, Ц. Луканова, M. Симонова, Н. Владов

Abstract

Тромбозата на порталната вена (ТПВ) често се забравя като възможна причина за коремните болки, системната портална енцефалопатия или гастро-интестиналното кървене от езофагеални варици, спленомегалия и или
асцит. Това може да усложни подлежащата патологията и да увеличи заболеваемостта и смъртността. Етиологиятаи патогенезата на тормобзата на вена порте може да е различна. Обикновено, диагнозата се поставя чрез дуплексдоплер ехография и/или цветна доплер ехография. Обещаващи методики са КТ, магнитно-резонансната ангиография
(MРA) и артериалната портография или спленопортография. Лечението и прогнозата при ТПВ зависят от етиологиятана заболяването. Тук ще представим два случая с тромбоза на порталната вена с различна етиология, както и обзор налитературата за диагностиката и лечението.


Keywords

portal vein thrombosis, hypertension, porto-systemic shunt

Full Text


References

Bayraktar Y,Harmanci O. Etiology and consequences of thrombosis in abdominal

vessels.World J Gastroenterol 2006;12:1165-1174

Wang JT,Zhao HY,Liu YL.Portal vein thrombosis. Hepatobiliary Pancreat Dis Int

;4:515-518

N. V. Jamieson, `Changing perspectives in portal vein thrombosis and liver transplantation,` Transplantation, vol. 69, no. 9, pp. 1772-1774, 2000

Amitrano L, Guardascione MA, Brancaccio V, Margaglione M, Manguso F, Iannaccone

L, Grandone E, Balzano A. Risk factors and clinical presentation of portal vein

thrombosis in patients with liver cirrhosis. J Hepatol 2004; 40: 736-741

Ogren M, Bergqvist D, Björck M, Acosta S, Eriksson H, Sternby NH. Portal vein

thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies. World J Gastroenterol 2006; 12: 2115-2119

Cohen J, Edelman RR, Chopra S. Portal vein thrombosis: a review. Am J Med 1992;

: 173-182

Turnes J, Garcı´a-Paga´n JC, Gonza´lez M, et al. Portal hypertension-related complications

after acute portal vein thrombosis: impact of early anticoagulation. Clin Gastroenterol

Hepatol 2008; 6: 1412-7

Pirisi M, Avellini C, Fabris C, Scott C, Bardus P, Soardo G, Beltrami CA, Bartoli E.

Portal vein thrombosis in hepatocellular carcinoma: age and sex distribution in an

autopsy study. J Cancer Res Clin Oncol 1998; 124: 397-400

Chawla Y, Duseja A, Dhiman RK. Review article: the modern management of portal

vein thrombosis. Aliment PharmacolTher 2009; 30: 881-894

Sogaard KK, Astrup LB, Vilstrup H, Gronbaek H. Portal vein thrombosis: risk factors,

clinical presentation and treatment. BMC Gastroenterology 2007;7:34.

Lebrec D, Bataille C, Bercoff E, Valla D. Hemodynamic changes in patients with

portal venous obstruction.( Hepatology 1983; 3: 550-553

Henderson JM, Gilmore GT, Mackay GJ, Galloway JR, Dodson TF, Kutner MH. Hemodynamics during liver transplantation: the interactions between cardiac output

and portal venous and hepatic arterial flows. Hepatology 1992; 16: 715-718

Ohnishi K, Okuda K, Ohtsuki T, Nakayama T, Hiyama Y, Iwama S, Goto N, et al. Formation of hilar collaterals or cavernous transformation after portal vein obstruction

by hepatocellular carcinoma. Observ. in ten patients. Gastroenter 1984; 87:1150-3

De Gaetano AM, Lafortune M, Patriquin H, De Franco A, Aubin B, Paradis K. Cavernous transformation of the portal vein: patterns of intrahepatic and splanchnic

collateral circulation detected with Doppler sonography. AJR Am JRoentgenol 1995;

: 1151-1155

Condat B, Valla D. Nonmalignant portal vein thrombosis in adults. Nat Clin Pract

Gastroenterol Hepatol 2006; 3: 505-515

Hoekstra J, Janssen HL. Vascular liver disorders (II): portal vein thrombosis. Neth J

Med 2009; 67: 46-53

Harmanci O, Bayraktar Y. Portal hypertension due to portal venous thrombosis: etiology, clinical outcomes. World JGastroenterol 2007; 13: 2535-2540

De Leve LD, Valla DC,Garcia-Tsao G. Vascular disorders of the liver. Hepatology

;49:1729-64

Amitrano L,Guardascione MA,Brancaccio V,Ma rgaglione M,Manguso F, Iannaccone

L,Grandone E et al. Risk Factors and clinical presentation of portal vein thrombosis

in patients with liver cirrhosis.J.Hepatol 2004;40:736-41

Tsochatzis EA, Senzolo M, Germani G, Gatt A,Burroughs AK. Systematic review:portal vein thrombosis in cirrhosis.Aliment Phermacol Ther 2010;31:366-74

Francoz C., Belghiti J,Vilgrain V, Sommacale D, Paradis V, Condat B et al. Splanchnic vein thrombosis in children for liver transplantation. Gut 2005;54:691-7

Dumortier J,Czyglik O,Poncet MC,Boucaud C,Henry L, Boillot O. Eversion thrombectomy for portal vein throJ.Transplant 2002;2:934-8

Gayowski TJ,Marino IR,Doyle HR,Echeverri L,Mieles L,Todo S,Wagener M, et al. A high incidence of native portal vein thrombosis in veterans undergoing liver transplantation .J.Surg Res 1996;60:333-8

Francoz C,Valla D, Durand F. Portal vein thrombosis and liver transplantation. J Hepatol 2012;57:203-12

Ponziani FR,Zacco MA,Senzolo M,Pompili M, Gasbarrini A, Avolio AW. Portal vein

thrombosis and liver transplantation: implication for waiting list period, surgical approach, early and late follow-up. Transplant Rev 2014; 28:92-101.

Duffy J, Hong J, Farmer F et al. Vascular complication of orthotopic liver transplantation: experience in more than 4200 patients. J Am Coll Surg 2009; 208:896-903

Kumar S, Sarr M, Kamath P. Mesenteric venous thrombosis. N Engl J Med 2001;

:1683-8.

Baril N, Wren S, Radin R, Ralla P, Stain S. The role of anticoagulation in pylephlebitis.

Am J Surg 1996; 172: 449-52.

Hidajat N, Stobbe H, Griesshaber V, Felix R, Schroder RJ. Imaging and radiological

interventions of portal vein thrombosis. Acta Radiol 2005; 46: 336-43

Webster G, Burroughs A, Ri ordan SM. Review article: portal vein thrombosis - new

insights into aetiology and management. Aliment Pharmacol Ther 2005; 21: 1-9.

Plessier A, Murad SD, Hernandez Guerra M, et al. A prospective multicentric follow

up study on 105 patients with acute portal vein thrombosis: results from EN-VIE.

Hepatology 2007; 46(suppl): 310A.

Sarin S, Sollano J, Chawla Y et al. Members of the APASL on portal hypertension.

Consensus on extra-hepatic portal vein obstruction. Liver Int 2006; 26: 512-9.

Hollingshead M,Burke CT,Mauro MA,Weeks SM, Dixon RG.Jaques PF. Transcatheter

thrombolyc therapy for acute mesenteric and portal vein thrombosis.J Vasc Interv

Radiol 2005;16:651-61

Og˘uzkurt P, Tercan F, Ince E, Ezer SS, Hic¸so¨nmez A. Percutaneous treatment of

portal vein thrombosis in a child who has undergone splenectomy. J Pediatr Surg

; 43: e29-32.

Adani GL, Baccarani U, Risaliti A, et al. Percutaneous transhepatic portography for

the treatment of early portal vein thrombosis after surgery. Cardiovasc Intervent

Radiol 2007; 30: 1222-6.

Livingstone AS, Koniaris LG, Perez EA, et al. 507 Warren-Zeppa distal splenorenal

shunts: a 34-year experience. Ann Surg 2006; 243: 884-92.

Sharma BC, Singh RP, Chawla YK, et al. Effect of shunt surgery on spleen size,

portal pressure and oesophageal varices in patients with non-cirrhotic portal hypertension.

J Gastroenterol Hepatol 1997; 12: 582-4.

Dasgupta R, Roberts E, Superina RA, Kim PC. Effectiveness of Rex shunt in the treatment of portal hypertension. J Pediatr Surg 2006; 41: 108-12.

Query JA, Sandler AD, Sharp WJ. Use of autogenous saphenous vein as a conduit

for mesenterico-left portal vein bypass. J Pediatr Surg 2007; 42: 1137-40.

Krebs-Schmitt D, Briem-Richter A, Grabhorn E, et al. Effectiveness of Rex shunt in children with portal hypertension following liver transplantation or with primary

portal hypertension. Pediatr Transplant 2009; 13: 540-4.

Kim HB, Pomposelli JJ, Lillehei CW, et al. Mesogonadal shunts for extrahepatic

portal vein thrombosis and variceal hemorrhage. Liver Transpl 2005; 11: 1389-94.

Warren WD, Henderson JM, Millikan WJ, et al. Management of variceal bleeding in

patients with noncirrhotic portal vein thrombosis. Ann Surg 1988; 207: 623-34.

Orloff MJ, Orloff MS, Girard B, Orloff SL. Bleeding esophagogastric varices from

extrahepatic portal hypertension: 40 years` experience with portal-systemic shunt. J

Am Coll Surg 2002; 194: 717-28.

Yamamoyo Teyoshi, Nagano Hiroakia et al. Patient with Hepatocellular Carcinoma

and Portal Vein Thrombosis in 1st Branch who Was Treated by Transcatheter Arterial

Embolisation. Japanese Journal of Cancer and Chemotherapy 2001; 28 (11): 1718-2

Shaw BW Jr, Iwatsuki S, Bron K, et al. Portal vein grafts in hepatic transplantation.

Surg Gynecol Obstet 1985; 161: 66- 8.

Llado´ L, Fabregat J, Castellote J et al. Management of portal vein thrombosis in

liver transplantation: influence on morbidityand. Clin Transplant 2007; 2: 716-21

Lendoire J, Raffin G, Cejas N, et al. Liver transplantation in adult patients with

portal vein thrombosis: risk factors, manag. outcome. HPB (Oxford) 2007; 9: 352-6.

Harmanci O, Bayraktar Y. Portal hypertension due to portal venous thrombosis: etiology, clinical outcomes. World J Gastroenterol2007; 13: 2535-40.

Yerdel MA, Gunson B, Mirza D, et al. Portal vein thrombosis in adults undergoing

liver transplantation : risk factors, screening, management and outcome. Transplantation

; 69: 1873-81.

Tao YF, Teng F, Wang ZX, et al. Liver transplant recipients with portal vein thrombosis: a single center retrospective study. Hepatobiliary Pancreat Dis Int 2009; 8: 34-9.

Doenecke A, Tsui TY, Zuelke C, et al. Pre-existent portal vein thrombosis in liver

transplantation: influence of preoperativedisease severity. Clin Transplant 2009; 19, Feb 19, PubMed.

Hajdu CH, Murakami T, Diflo T, et al. Intrahepatic portal cavernoma as an indication for liver transplantation. Liver Transpl 2007; 13: 1312-6.




DOI: http://dx.doi.org/10.14748/sm.v0i2.1836

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