Progress in diagnosis and treatment of acute portal vein thrombosis after hepatectomy
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1.Graduate School, Qinghai University, Xining 810000, China;2.Hepatobiliary and Pancreatic Center, Beijing Tsinghua Changgung Hospital, Beijing 102218, China;3.Department of Hepatobiliary Surgery, Affiliated Hospital of Qinghai University, Xining 810000, China

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R735.7

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    Abstract:

    Portal vein thrombosis (PVT) refers to thrombosis that occurs in the portal vein system and (or) its branches. Acute PVT after hepatectomy refers to the thrombotic state that occurs within 30 d after operation, or before the formation of collateral circulation of the portal vein. If there is no timely intervention, the thrombus will spread along the portal vein system, resulting in a sharp decrease in hepatic blood flow, high risk of serious complications such as liver failure and high mortality. There are great differences in the incidence and mortality rates for PVT after hepatectomy in domestic and foreign literature. The incidence reported in domestic literature is low, but the mortality is high. Acute PVT after hepatectomy have complex etiologies, and there are many risk factors, including non-operative factors (liver cirrhosis, hepatocellular carcinoma, advanced age) and surgical factors ( frequent and prolonged inflow occlusion, combination with portal vein reconstruction, right trisectionectomy or right hemihepatectomy, major hepatectomy, caudate lobectomy, synchronous splenectomy, long operative time, bile leakage, extrahepatic bile duct resection, etc.). The clinical manifestation of the patients is unspecific, and some patients do not have any symptoms and signs, which leads to the difficulty of early diagnosis. The obvious changes of D-dimer as well as the sudden and sharp deterioration of liver function indexes during their improvements after hepatectomy have diagnostic significance, but PVT after hepatectomy is mainly diagnosed by imaging examination, and abdominal enhanced CT have high sensitivity and specificity. At present, there is no clear prophylaxis and treatment guidelines.For patients with risk factors for thrombosis, the blood determination of thrombin-antithrombin III complex, D-dimer, antithrombin Ⅲ and soluble form of glycoprotein VI has a certain value in predicting postoperative PVT. For patients with risk factors for PVT, it is recommended that enhanced CT should be performed routinely to screen PVT. The treatment methods include anticoagulation, thrombolysis and thrombectomy, and individualized treatment should be selected through accurate evaluation of patients. There are no clear prevention and treatment guidelines for PVT after hepatectomy. Early detection and early treatment are the keys to improve the prognosis of patients. By searching the literature concerning PVT after hepatectomy at home and abroad, the authors summarize the latest research results on risk factors, clinical manifestations, diagnosis, treatment and prophylaxis of PVT after hepatectomy.

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CHEN Baojun, WANG Liang, YAN Zhe, TONG Xuan, WANG Kaiyu, XIAO Ming, HUANG Xin, ZHANG Qijia, ZHANG Qiming, ZHANG Lingkai, LI Decai, XIANG Canhong. Progress in diagnosis and treatment of acute portal vein thrombosis after hepatectomy[J]. Chin J Gen Surg,2022,31(2):268-276.
DOI:10.7659/j. issn.1005-6947.2022.02.016

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History
  • Received:December 26,2021
  • Revised:January 28,2022
  • Adopted:
  • Online: March 04,2022
  • Published: