hepatoАнналы хирургической гепатологииAnnaly khirurgicheskoy gepatologii = Annals of HPB Surgery1995-54642408-9524НЭИКОН ИСП10.16931/1995-5464.2015145-58hepato-252Research ArticleДИАГНОСТИКА И ЛЕЧЕНИЕ БОЛЬНЫХ С ПОРТАЛЬНОЙ ГИПЕРТЕНЗИЕЙDIAGNOSIS AND TREATMENT OF PORTAL HYPERTENSIONВнепеченочная портальная гипертензия и тромбоз воротной вены (обзор литературы)Extrahepatic Portal Hypertension and Portal Vein Thrombosis (Review)ФандеевЕ. Е.FandeyevE. E.

канд. мед. наук, младший научный сотрудник отделения экстренной хирургии и портальной гипертензии, ФГБНУ “Российский научный центр хирургии им. акад. Б.В. Петровского”

Cand. of Med. Sci., Junior Research Assistant at the Department of Urgent Surgery and Portal Hypertension of academician B.V. Petrovsky Russian Research Surgery Center

dr.fan@inbox.ruЛюбивыйЕ. Д.LyubiviyE. D.

канд. мед. наук, заместитель главного врача по лечебной работе ФГБНУ “Российский научный центр хирургии им. акад. Б.В. Петровского”; старший научный сотрудник отделения экстренной хирургии и портальнойгипертензии, ФГБНУ “Российский научный центр хирургии им. акад. Б.В. Петровского”

Cand. of Med. Sci., Deputy Chief Physician for Patient Care of academician B.V. Petrovsky Russian Research Surgery Center; Senior Research Assistant at the Department of Urgent Surgery and Portal Hypertension of academician B.V. Petrovsky RussianResearch Surgery Center.

ГонсалвесГонсалез Д.GonçalvezGonçalez D.

клинический ординатор кафедры анестезиологии и реаниматологии, ГБОУ ВПО “Первый Московский государственный медицинский университет им. И.М. Сеченова” Минздрава России

Resident at the Chair of Anestesiology and Reanimatology of I.M. Sechenov First Moscow State Medical University

СысоеваЕ. П.SysoyevaE. P.

канд. мед. наук, старший научный сотрудник отделения орфанных заболеваний, ФГБУ “Гематологический научный центр” Министерства здравоохранения РФ.

Cand. of Med. Sci., Senior Research Assistant at the Department of Orphan Diseases of Scientific Hematology Center

КиценкоЕ. А.KitsenkoE. A.

доктор мед. наук, ведущий научный сотрудник отделения экстренной хирургии и портальной гипертензии, ФГБНУ “Российский научный центр хирургии им. акад.Б.В. Петровского”

Doct. of Med. Sci., Leading Research Assistant at the Department of Urgent Surgery and Portal Hypertension of academician B.V. Petrovsky Russian Research Surgery Center

Отделение экстренной хирургии и портальной гипертензии Российского научного центра хирургии им. акад. Б.В. ПетровскогоРоссияDepartment of Urgent Surgery and Portal Hypertension of academician B.V. Petrovsky Russian Research Surgery CenterRussian FederationКафедра анестезиологии и реаниматологии Первого Московского государственного медицинского университета им. И.М. Сеченова Минздрава РоссииРоссияChair of Anestesiology and Reanimatology of I.M. Sechenov First Moscow State Medical University, Health Ministry of the Russian FederationRussian FederationОтделение орфанных заболеваний Гематологического научного центра Министерства здравоохранения РФРоссияDepartment of Orphan Diseases of Scientific Hematology Center, Health Ministry of the Russian FederationRussian Federation2015260320182014558Copyright © Фандеев Е.Е., Любивый Е.Д., Гонсалвес Г.Д., Сысоева Е.П., Киценко Е.А., 20182018Фандеев Е.Е., Любивый Е.Д., Гонсалвес Г.Д., Сысоева Е.П., Киценко Е.А.Fandeyev E.E., Lyubiviy E.D., Gonçalvez G.D., Sysoyeva E.P., Kitsenko E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://hepato.elpub.ru/jour/article/view/252

Внепеченочный тромбоз воротной вены – вторая по частоте причина портальной гипертензии после цирроза печени. Факторы риска тромбоза разделяют на системные: наследственные и приобретенные тромбофилии (60–70%); и локальные: воспалительные заболевания брюшной полости, травмы, операции и пр. (20–40%). Проявления острого тромбоза, как правило, малосимптомны, и он остается недиагностированным до развитияосложнений портальной гипертензии: варикозных кровотечений, портальной билиопатии и пр. Рекомендовано как можно более раннее начало антикоагулянтной терапии, по меньшей мере в течение 3 мес. У больных с портальной каверномой длительная (вплоть до пожизненной) антикоагулянтная терапия направлена на предупреждение рецидива и распространения тромбоза, особенно при тромбофилии. Портокавальное шунтированиеявляется наиболее радикальным методом лечения, избавляя больного от варикозных кровотечений и других осложнений. Проявления печеночной энцефалопатии являются редким явлением и носят субклинический характер. Эндоскопическое лигирование и склеротерапия являются эффективным методом первичной и вторичной профилактики варикозных кровотечений и должны быть дополнены назначением неселективныхβ-адреноблокаторов. Высокая толерантность к кровотечениям и высокий уровень выживаемости больных объясняются сохранной функцией печени. Летальность среди пациентов (уровень 5-летней летальности – ниже 10%) связана большей частью с сопутствующей патологией, а не с осложнениями портальной гипертензии

Extrahepatic portal vein thrombosis is the second most frequent cause of portal hypertension after liver cirrhosis. Risk factors of the thrombosis are divided into systemic: hereditary and acquired thrombophilia (60–70%); and local: abdominal inflammation, trauma, surgery, etc. (20–40%). Acute thrombosis episode is often olygo- or asymptomatic and remains undiagnosed until the development of portal hypertension and its complications: gastroesophageal variceal bleeding, portal biliopathy, etc. Early onset of anticoagulation is recommended and should be prescribed at least for 3 months. In patients with portal cavernoma a long-term (even lifelong) anticoagulation is directed to prevent recurrence and extension of thrombosis, especially in case of thrombophilia. Portocaval shunting is the most radical way to correct portal hypertension and to deliver a patient from variceal bleedings and other complications of the disease. Hepatic encephalopathy is a rarecondition and generally subclinical. Endoscopic band ligation and sclerotherapy are effective in acute variceal bleeding, primary and secondary prophylaxis of bleeding and should be supplied by non-selective β-adrenoblockers administration. Patients with extrahepatic portal vein thrombosis are well tolerated to variceal bleeding episodes and have high rates of survival during long-term follow-up due to normal liver function. Mortality in these patients is low (5-year mortality is less than 10%) and generally is associated with comorbidities rather complications of portal hypertension

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The authors declare that there are no conflicts of interest present.