Research progress in perioperative management of portal vein thrombosis in liver transplantation
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摘要: 门静脉血栓是肝硬化的常见并发症之一，其发生率随着疾病的发展而增加。门静脉血栓的发生发展与多种因素有关，抗凝治疗的指征仍需进一步研究探索。门静脉血栓目前已不再认为是肝移植手术的禁忌，但是复杂的门静脉血栓会增加肝移植围手术期风险，如何恢复门静脉系统血流是临床手术方案决策的难点，合理的术前分型、手术规划和门静脉重建方式是保障肝移植受者远期良好预后的关键。本文就门静脉血栓的流行病学现状、危险因素、分型与鉴别，肝移植术前门静脉血栓管理和术中处理，以及门静脉血栓对肝移植结局的影响进行综述，为肝移植围手术期门静脉血栓的管理提供参考。Abstract: Portal vein thrombosis is one of the common complications of liver cirrhosis. The incidence of portal vein thrombosis is increased with the progression of diseases. The incidence and progression of portal vein thrombosis are associated with multiple factors. The indications of anticoagulant therapy remain to be investigated. At present, portal vein thrombosis is no longer considered as a contraindication for liver transplantation. Nevertheless, complicated portal vein thrombosis will increase perioperative risk of liver transplantation. How to restore the blood flow of portal vein system is a challenge for surgical decision-making in clinical practice. Rational preoperative typing, surgical planning and portal vein reconstruction are the keys to ensure favorable long-term prognosis of liver transplant recipients. In this article, epidemiological status, risk factors, typing and identification of portal vein thrombosis, preoperative and intraoperative management of portal vein thrombosis in liver transplantation, and the impact of portal vein thrombosis on the outcomes of liver transplantation were reviewed, aiming to provide reference for perioperative management of portal vein thrombosis throughout liver transplantation.
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