Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hyperten...Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hypertension(CSPH).However,there is still no research to explore the outcomes of laparoscopic versus open liver resection(OLR)in the specific patients with BCLC stage 0-A HCC and CSPH.Methods:Patients diagnosed with BCLC stage 0-A HCC and CSPH who underwent liver resection at West China Hospital of Sichuan University from February 2018 to December 2022 were analyzed.Demographic characteristics,pathological findings and postoperative outcomes were compared using propensity score matching(PSM).Long-term outcomes after surgery were analyzed using Kaplan-Meier analysis both before and after PSM.Results:A total of 409 patients,including 261 LLRs and 148 OLRs,were enrolled in this study.There were imbalances between the groups in baseline information.After 1:1 PSM,118 patients were included in each group with comparable baseline characteristics.Patients in the LLR group had significantly less intraoperative blood loss compared to those in the OLR group(median 223 vs.318 mL,P<0.001),and fewer postoperative complications(33.9%vs.57.6%,P<0.001),including lower rates of postoperative liver decompensation(16.9%vs.28.0%,P=0.043),postoperative ascites(18.6%vs.31.4%,P=0.024)and pulmonary infections(12.7%vs.29.7%,P=0.001).The long-term follow-up showed that overall survival(P=0.154)and recurrence-free survival(P=0.376)were comparable between the two groups.In subgroup analysis,patients with PLT≤75×10^(9)/L suffered more postoperative liver decompensation(PLD)and ascites than patiens with PLT>75×10^(9)/L.Conclusions:Compared with OLR,LLR had less intraoperative blood loss,fewer postoperative complications and comparable oncological outcomes for patients with BCLC stage 0/A HCC and CSPH.展开更多
Non-cirrhotic portal hypertension(PHT)accounts for about 20%of all PHT cases,portal vein thrombosis(PVT) resulting in cavernous transformation being the most common cause.All known complications of PHT may be encounte...Non-cirrhotic portal hypertension(PHT)accounts for about 20%of all PHT cases,portal vein thrombosis(PVT) resulting in cavernous transformation being the most common cause.All known complications of PHT may be encountered in patients with chronic PVT.However,the effect of this entity on the biliary tree and pancreatic duct has not yet been fully established.Additionally,a dispute remains regarding the nomenclature of common bile duct abnormalities which occur as a result of chronic PVT.Although many clinical reports have focused on biliary abnormalities,only a few have evaluated both the biliary and pancreatic ductal systems.In this review the relevant literature evaluating the effect of PVT on both ductal systems is discussed,and findings are considered with reference to results of a prominent center in Turkey,from which the term"portal ductopathy"has been put forth to replace"portal biliopathy".展开更多
Portal hypertension is a critical determinant of prognosis in chronic liver disease and a key factor in evaluating candidates for liver transplantation.Traditional methods such as hepatic venous pressure gradient(HVPG...Portal hypertension is a critical determinant of prognosis in chronic liver disease and a key factor in evaluating candidates for liver transplantation.Traditional methods such as hepatic venous pressure gradient(HVPG)measurement have long been considered the gold standard for assessing portal pressure.However,these methods are invasive and carry procedural limitations.Recent advances in endoscopic ultrasound(EUS)-guided techniques have emerged as promising alternatives,offering direct and minimally invasive assessment of portal pressure.EUS-guided portal pressure gradient measurement enables real-time evaluation of haemodynamic through direct access to the portal system.This technique has shown to be as accurate as HVPG,and it has some extra benefits,like the ability to take liver biopsies and check collateral circulation all at the same time.Despite these benefits,the technique poses challenges such as operator dependence,proce-dural complexity,and limited standardization across centres.This minireview highlights the evolution of portal pressure measurement,focusing on the potential of EUS-guided techniques in pre-transplant assessment,risk strati-fication,and monitoring therapeutic outcomes.Furthermore,it discusses the technical challenges,clinical implications,and future directions for integrating these innovations into routine practice.Advances in portal pressure measurement hold significant promise for enhancing decision-making and outcomes in liver transplantation.展开更多
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is contraindicated for patients with cavernous transformation of the portal vein(CTPV)due to high surgery-related mortality risk.However,surgically assiste...BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is contraindicated for patients with cavernous transformation of the portal vein(CTPV)due to high surgery-related mortality risk.However,surgically assisted TIPS(SATIPS)can significantly reduce the risk.AIM To evaluate the clinical efficacy of SATIPS,this study was conducted.METHODS One hundred and seven patients with CTPV and esophagogastric variceal bleeding were recruited from January 2023 to December 2024.The patients were recruited from three different hospitals.Overall,54 patients received SATIPS treatment(SATIPS group),while 53 patients did not receive SATIPS and underwent prophylactic endoscopic sclerosing ligation(control group).Subsequently,survival rates,incidence rates of gastrointestinal bleeding,incidence of hepatic encephalopathy rate,and the incidence of liver failure after treatment in both groups at 3 and 6 months were observed.RESULTS The survival rates for the SATIPS and control groups were 94.4%and 92.5%at 3 months(P value=0.72)and 94.4%and 73.6%at 6 months(P value=0.0051)respectively.The incidence of liver failure was 3.7%and 9.4%at 3 months(P value=0.26)and 3.7%and18.9%at 6 months(P value=0.016);the incidence of gastrointestinal bleeding was 5.6%and 37.7%at 3 months(P value<0.001)and 9.3%and 47.2%(P value<0.001)at 6 months;and the incidence of hepatic encephalopathy was 3.7%and 17.0%at 3 months(P value=0.026)and 7.4%and 26.4%at 6 months(P value=0.026)respectively.CONCLUSION For patients with CTPV,there were no optimal treatment.Regarding long-term efficacy,SATIPS can significantly reduce the rate of rebleeding,hepatic encephalopathy and liver failure,and is associated with better survival.展开更多
BACKGROUND: Non-cirrhotic portal hypertension is acommon cause of portal hypertension in developing coun-tries. To understand its etiopathogenesis we developed ananimal model by repeated portal endotoxemia inducedthro...BACKGROUND: Non-cirrhotic portal hypertension is acommon cause of portal hypertension in developing coun-tries. To understand its etiopathogenesis we developed ananimal model by repeated portal endotoxemia inducedthrough the gastrosplenic vein.METHODS: Twenty-nine rabbits (1.5-2.0 kg) were divid-ed into control (group n = 13) and experimental ( groupn = 16) groups. Heat killed E. coli were injected throughan indwelling cannula into the gastrosplenic vein in pre-sensitized animals. The animals were sacriflced at 1, 3 and6 months.RESULTS: The mean portal pressure in group animalswas significantly (P < 0. 05) higher than in group at 1(17.5 ±3.4 vs 10.4±2.2 mmHg), 3 (17.8±1.3 vs7.2 +3.6mmHg), and 6 (19.8±3.1 vs 10.3±4.8 mmHg) months.Similarly, the mean splenic weight in group was signifi-cantly greater than in group (P <0.05). Histopathologi-cally, the spleen showed medullary congestion, hemosid-rin-laden macrophages and mild fibrosis. Histologically,the liver had normal parenchyma with mild portal lympho-cytic infiltrates and kupffer cell hyperplasia. No significantanomalies were detected by liver function tests.CONCLUSIONS: The rabbit model showed significantsplenomegaly with a persistent increase in portal pressureand mild fibrosis without hepatic parenchymal injury, quiteakin to non-cirrhotic portal fibrosis as seen in humans. Re-current intra-abdominal infection may play an importantrole in the pathogenesis of non-cirrhotic portal fibrosis.展开更多
Portal hypertension(PH)is a major complication of chronic liver disease,often leading to serious clinical consequences such as variceal bleeding,ascites,and splenomegaly.The current gold standard for PH diagnosis,name...Portal hypertension(PH)is a major complication of chronic liver disease,often leading to serious clinical consequences such as variceal bleeding,ascites,and splenomegaly.The current gold standard for PH diagnosis,namely,hepatic venous pressure gradient measurement,is invasive and not widely available.Transient elastography has emerged as a non-invasive alternative for assessing liver stiffness(LS),and recent studies have highlighted the potential role of splenic stiffness(SS)in evaluating PH severity.This narrative review summarizes the available evidence on the utility of splenic transient elastography in assessing PH.We evaluated its diagnostic accuracy,technical challenges,and clinical applications,particularly in distinguishing between cirrhotic PH(CPH)and noncirrhotic PH(NCPH).A comprehensive literature search was conducted using the PubMed database,focusing on studies that assess splenic elastography in the diagnosis and prognosis of PH.This review compares splenic elastography with other non-invasive imaging modalities,including MR elastography and shearwave elastography.Additionally,we examined the role of SS using elastography in predicting the presence of esophageal varices and its potential impact on reducing the need for endoscopic screening.Studies have demonstrated that splenic elastography correlates well with PH severity,with cut-off values ranging between 45 kPa and 50 kPa for significant PH detection.Splenic elastography,when combined with platelet count and LS measurements,improves diagnostic accuracy and risk stratification for the occurrence of variceal bleeding.Despite its clinical promise,technical challenges such as patient positioning,body habitus,and probe selection remain key limitations.Notably,splenic elastography may be particularly useful in diagnosing NCPH,where LS remains normal but PH is present.Splenic transient elastography is a valuable adjunct in the non-invasive assessment of PH.Its ability to predict varices,differentiate between CPH and NCPH,and reduce unnecessary endoscopies suggests that it should be incorporated into routine hepatology practice.Future research should focus on refining SS cut-offs,evaluating its cost-effectiveness,and integrating splenic elastography into clinical guidelines for PH management.展开更多
BACKGROUND The hepatosplenic schistosomiasis(HSS)with portal hypertension can cause vascular complications such as hepatopulmonary syndrome(HPS).HPS increases the risk of mortality in patients with cirrhosis;however,t...BACKGROUND The hepatosplenic schistosomiasis(HSS)with portal hypertension can cause vascular complications such as hepatopulmonary syndrome(HPS).HPS increases the risk of mortality in patients with cirrhosis;however,there is no data on the mortality of patients with HSS and HPS.AIM To perform a survival analysis of patients with HPS related to cirrhotic and non-cirrhotic(schistosomiasis)portal hypertension.METHODS From August 2023 to January 2024,medical records and the official mortality information service of 121 patients who participated in a cross-sectional study on HPS between 2010 and 2012 were analyzed.Survival curves were created using the Kaplan-Meier method,and comparisons were performed using the log-rank test.Cox regression models estimated the hazard ratios(HR).RESULTS Overall,data of 113 patients were analyzed;most(55.8%)had HSS and concomitant cirrhosis(HSS/cirrhosis).Meanwhile,HPS was present in 39(34.5%)patients.Death occurred in 65 patients[57.5%];95%confidence interval(CI):48%-67%.The average time to death was lower in those with HPS when compared to those without HPS(3.37 years vs 5.65 years;P=0.017).According to the cause of liver disease,patients with HSS/cirrhosis died earlier,and their risk of death was twice as high compared with patients with HSS without cirrhosis(HR:2.17;95%CI:1.3-3.60;P=0.003).Meanwhile,there were no differences when comparing the two groups with and without HPS(HR:1.01;95%CI:0.59-1.73;P=0.967).CONCLUSION Patients with HSS and concomitant cirrhosis had a lower survival rate,but there was no difference in survival regardless of the presence of HPS.展开更多
Non-tumoral portal vein thrombosis(PVT)is a frequent and challenging complication in liver transplant candidates.The prevalence reaches up to 26%in patients with cirrhosis on a transplant waiting list.Its severity inc...Non-tumoral portal vein thrombosis(PVT)is a frequent and challenging complication in liver transplant candidates.The prevalence reaches up to 26%in patients with cirrhosis on a transplant waiting list.Its severity increases with liver disease progression and significantly impacts post-transplant outcomes.Advanced PVT increases postoperative mortality to 30%.Effective management requires a multidisciplinary approach,especially in advanced cases.Preoperative strategies emphasize anticoagulation with low molecular weight heparin,while interventional radiology,including transjugular intrahepatic portosystemic shunts,offers alternatives in some cases.Intraoperatively,management is guided by PVT classification systems,ranging from thrombectomy and portal vein reconstruction to non-physiological reconstructions in complex cases.This manuscript explores the management of PVT in liver transplantation candidates,discusses strategies to optimize outcomes,and presents our institutional protocol for addressing this high-risk condition.展开更多
Portal vein thrombosis(PVT)is one of the most common serious complications in patients with liver cirrhosis.The occurrence of PVT not only aggravates the condition of liver cirrhosis but can also cause several serious...Portal vein thrombosis(PVT)is one of the most common serious complications in patients with liver cirrhosis.The occurrence of PVT not only aggravates the condition of liver cirrhosis but can also cause several serious complications,such as portal hypertension,esophagogastric variceal bleeding,and refractory ascites.All these factors have a serious impact on patients’quality of life and prognosis.This article evaluates the current evidence on the management of PVT in cirrhosis and explores the role of direct oral anticoagulants,but data on individualized anticoagulation strategies are limited and lacking for the treatment of PVT in cirrhosis,and it is hoped that it will inform a broad range of clinicians on the treatment of cirrhosis combined with PVT.展开更多
Clinically significant Portal hypertension(PH),defined by a hepatic venous pressure gradient(HVPG)greater than 10 mmHg,is a key predictor of decompensation events in cirrhosis,leading to variceal hemorrhage,ascites,an...Clinically significant Portal hypertension(PH),defined by a hepatic venous pressure gradient(HVPG)greater than 10 mmHg,is a key predictor of decompensation events in cirrhosis,leading to variceal hemorrhage,ascites,and hepatic encephalopathy.This narrative review explores the pathophysiology of PH in cirrhosis,evaluates diagnostic methods for identifying clinically significant PH(CSPH),and discusses guideline-driven strategies to prevent initial and further decompensation.While HVPG remains the gold standard for diagnosing CSPH,non-invasive tools such as liver stiffness measurement and spleen stiffness measurement are increasingly used for initial risk stratification.The combined use of these tools reduces the proportion of patients in the diagnostic"grey zone".Endoscopic ultrasound-guided portal pressure gradient is an emerging diagnostic tool that requires further validation.Non-selective beta-blockers are the cornerstone of primary prophylaxis for decompensation,and their combination with endoscopic variceal ligation is the first-line therapy for secondary prophylaxis of recurrent esophageal variceal bleeding.Statins show promise in reducing PH and preventing decompensation while further studies are still needed.This review also discusses the indications for preemptive transjugular intrahepatic portosystemic shunt and its role in managing refractory ascites and variceal bleeding.展开更多
Liver-directed therapies such as resection,ablation,and embolization offer potentially curative options for patients with primary and metastatic liver tumors as part of multidisciplinary oncology care.However,these tr...Liver-directed therapies such as resection,ablation,and embolization offer potentially curative options for patients with primary and metastatic liver tumors as part of multidisciplinary oncology care.However,these treatments pose significant hepatic decompensation risks,particularly with underlying liver disease and chemotherapy-associated steatohepatitis.Accurate assessment of liver function and portal hypertension(PH)is critical for candidate selection.While Child-Pugh score and model for end-stage liver disease are commonly used,they have substantial limitations.Hepatic venous pressure gradient(HVPG)measurement remains the gold standard for assessing PH but is invasive and not widely available.Endoscopic ultrasound(EUS)guided portal pressure gradient(PPG)measurement has emerged as a promising minimally invasive alternative.EUSPPG demonstrates excellent technical success rates,safety profile,and correlation with HVPG in early studies.By providing direct portal pressure measurement,EUS-PPG offers several advantages over existing methods for prognostication and risk stratification prior to liver-directed therapies,particularly in detecting presinusoidal hypertension.Furthermore,it has potential applications in assessing response to neoadjuvant treatments and guiding adjuvant therapies.However,research is needed to validate its predictive performance and cost-effectiveness in larger prospective cohorts and to establish its accuracy compared to non-invasive assessment of liver function.展开更多
Idiopathic portal hypertension is one of the interesting causes of portal hypertension. Even in very developed medical centers, this disorder is still one of the most important misdiagnoses of clinical practice. To in...Idiopathic portal hypertension is one of the interesting causes of portal hypertension. Even in very developed medical centers, this disorder is still one of the most important misdiagnoses of clinical practice. To inexperienced physicians, presenting esophageal varices and upper gastrointestinal bleeding usually prompt an unfortunate diagnosis of cirrhosis. A heterogenous clinical presentation and progression of this disorder should be recognized by physicians, and management should be directed towards some specific problems confined to this disorder. Although a genetic basis and other factors are implicated in its pathogenesis, exact underlying mechanism(s) is (are) unknown. In this review, we discuss the heterogeneity of idiopathic portal hypertension, its etiopathogenesis, clinical presentation and management issues. With the expectation of an excellent prognosis, a practicing gastroenterologist should be aware that "not all varices mean cirrhosis".展开更多
Portal vein embolization(PVE)is currently considered the standard of care to improve the volume of an inadequate future remnant liver(FRL)and decrease the risk of post-hepatectomy liver failure(PHLF).PHLF remains a si...Portal vein embolization(PVE)is currently considered the standard of care to improve the volume of an inadequate future remnant liver(FRL)and decrease the risk of post-hepatectomy liver failure(PHLF).PHLF remains a significant limitation in performing major liver surgery and is the main cause of mortality after resection.The degree of hypertrophy obtained after PVE is variable and depends on multiple factors.Up to 20%of patients fail to undergo the planned surgery because of either an inadequate FRL growth or tumor progression after the PVE procedure(usually 6-8 wk are needed before surgery).The management of PVE failure is still debated,with a lack of consensus regarding the best clinical strategy.Different additional techniques have been proposed,such as sequential transarterial chemoembolization followed by PVE,segment 4 PVE,intra-portal administration of stem cells,dietary supplementation,and hepatic vein embolization.The aim of this review is to summarize the up-to-date strategies to overcome such difficult situations and discuss future perspectives on improving FRL hypertrophy.展开更多
BACKGROUND Post-hepatectomy liver failure(PHLF)after liver resection is one of the main complications causing postoperative death in patients with hepatocellular carcinoma(HCC).It is crucial to help clinicians identif...BACKGROUND Post-hepatectomy liver failure(PHLF)after liver resection is one of the main complications causing postoperative death in patients with hepatocellular carcinoma(HCC).It is crucial to help clinicians identify potential high-risk PHLF patients as early as possible through preoperative evaluation.AIM To identify risk factors for PHLF and develop a prediction model.METHODS This study included 248 patients with HCC at The Second Affiliated Hospital of Air Force Medical University between January 2014 and December 2023;these patients were divided into a training group(n=164)and a validation group(n=84)via random sampling.The independent variables for the occurrence of PHLF were identified by univariate and multivariate analyses and visualized as nomograms.Ultimately,comparisons were made with traditional models via receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).RESULTS In this study,portal vein width[odds ratio(OR)=1.603,95%CI:1.288-1.994,P≤0.001],the preoperative neutrophil-to-lymphocyte ratio(NLR)(OR=1.495,95%CI:1.126-1.984,P=0.005),and the albumin-bilirubin(ALBI)score(OR=8.868,95%CI:2.144-36.678,P=0.003)were independent risk factors for PHLF.A nomogram prediction model was developed using these factors.ROC and DCA analyses revealed that the predictive efficacy and clinical value of this model were better than those of traditional models.CONCLUSION A new Nomogram model for predicting PHLF in HCC patients was successfully established based on portal vein width,the NLR,and the ALBI score,which outperforms the traditional model.展开更多
In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following tran...In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following transjugular intrahepatic portosystemic shunt(TIPS)and the implications for understanding the mechanisms,diagnosis,and treatment.By comparing the gut microbiota composition and dynamic changes before and after TIPS in patients with and without hepatic encephalopathy,the authors found an increase in non-probiotic bacteria in those who developed hepatic encephalopathy post-TIPS,with Morganella species present only in the hepatic encephalopathy group.The gut microbiota changes post-TIPS among patients without the occurrence of hepatic encephalopathy suggest potential therapeutic benefits through prophylactic microbiome therapies.Furthermore,the specific gut microbiota alterations may hold promise to predict the risk of hepatic encephalopathy in individuals undergoing TIPS for HBVrelated PH.Despite these promising findings,future studies are needed to address limitations,including a small sample size,a relatively short evaluation period for gut microbiota alterations,the absence of data on dynamic alterations in gut microbiota post-TIPS and their correlation with blood ammonia levels,and the lack of validation in animal models.In conclusion,Zhao et al's study has shed new light on the link of gut microbiota with post-TIPS hepatic encephalopathy,potentially through the intricate gut-liver axis,and has important clinical implications for improving the management of patients with HBV-related PH.展开更多
To address the severe aerodynamic effects caused by a 600 km/h superconducting maglev train passing through a tunnel at full speed,this study systematically investigates the coupled influence of auxiliary facility par...To address the severe aerodynamic effects caused by a 600 km/h superconducting maglev train passing through a tunnel at full speed,this study systematically investigates the coupled influence of auxiliary facility parameters including the shaft(location L,cross sectional dimension W,height h),tunnel portal(cross sectional area S),and openings(spacing D,side length F)on the evolution of tunnel aerodynamic effects.By integrating three dimensional unsteady flow field numerical simulations with a dynamic model testing system,the research notably reveals the regulatory mechanisms of these parameters on the evolution characteristics of the initial compression wave pressure gradient and the multi peak structure of micro-pressure waves.The results show that shaft parameters significantly affect the initial compression wave.Both the wave amplitude and gradient exhibit a linear negative correlation with cross sectional dimension W and a linear positive correlation with location L,while demonstrating a nonlinear relationship with height h,the amplitude follows a cubic polynomial trend,and the gradient initially increases before plateauing.Under the configuration W=8 m,L=50 m,and h=20 m,substantial reductions in both compression wave amplitude and gradient were achieved.The portal cross sectional area S shows a"U-shaped"relationship with the compression wave gradient,with the maximum gradient reduction of 53.24%occurring at S=210 m^(2),a result comparable to that achieved with optimized opening parameters(D=15 m,F=3.5 m,53.96%).Regarding micro-pressure waves,the amplitude measured 20 m from the tunnel exit shows a linear positive correlation with shaft parameters L and W,while the influence of h saturates beyond 50 m.Reductions exceeding 54%were achieved with portal parameters,either at S=210 m^(2) or using the optimized opening configuration.Furthermore,micro-pressure waves near the portal exhibit a consistent dual peak structure:the first peak originates from the train entry compression wave,and the second results from further wave compression after tunnel exit.The opening location governs selective peak regulation openings near the portal entrance primarily suppress the first peak with minimal impact on the second,whereas centrally located openings reduce the first peak but can amplify the second by up to 3%.Based on these insights,an optimized parameter configuration is proposed:a shaft with a cross-sectional dimension≥8 m located 50 m from the portal,a portal cross sectional area of 210 m^(2),and openings spaced at 15 m intervals.This configuration can reduce the initial compression wave gradient by over 50%.The results provide a theoretical foundation for controlling aerodynamic effects of superconducting maglev train.展开更多
Esophagogastric variceal bleeding is a common and severe complication of cirr-hotic portal hypertension.Hepatic venous pressure gradient measurement and esophagogastroduodenoscopy are the diagnostic gold standards for...Esophagogastric variceal bleeding is a common and severe complication of cirr-hotic portal hypertension.Hepatic venous pressure gradient measurement and esophagogastroduodenoscopy are the diagnostic gold standards for portal hyper-tension and esophagogastric variceal bleeding,respectively.With advancements in artificial intelligence in medicine,non-invasive diagnostic methods are in-creasingly replacing traditional invasive procedures,permitting more rational and personalized patient care.This review summarizes the formation and diagnosis of portal hypertension,as well as the primary prophylaxis,secondary prophylaxis,and management of acute esophagogastric variceal bleeding.This study also highlights the latest progress in artificial intelligence in the diagnosis and treat-ment of portal hypertension and esophagogastric varices.展开更多
BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated ...BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated with PH-PVT.METHODS Medical records of patients who underwent hepatic resection for various diseases between February 2014 and December 2023 at Beijing Tsinghua Changgung Hospital affiliated with Tsinghua University(Beijing,China)were retrospectively reviewed.The patients were divided into a PH-PVT group and a non-PH-PVT group.Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PH-PVT.RESULTS A total of 1064 patients were included in the study cohort,and the incidence and mortality rates of PH-PVT were 3.9%and 35.7%,respectively.The median time from hepatectomy to the diagnosis of PH-PVT was 6 days.Multivariate analysis revealed that hepatectomy combined with pancreaticoduodenectomy(HPD)[odds ratio(OR)=7.627(1.390-41.842),P=0.019],portal vein reconstruction[OR=6.119(2.636-14.203),P<0.001]and a postoperative portal vein angle<100°[OR=2.457(1.131-5.348),P=0.023]were independent risk factors for PH-PVT.Age≥60 years[OR=8.688(1.774-42.539),P=0.008]and portal vein reconstruction[OR=6.182(1.246-30.687),P=0.026]were independent risk factors for mortality in PH-PVT patients.CONCLUSION Portal vein reconstruction,a postoperative portal vein angle<100°and HPD were independent risk factors for PHPVT.Age≥60 years and portal vein reconstruction were independent risk factors for mortality in PH-PVT patients.展开更多
基金supported by grants from the Sichuan Science and Technology Program(2023YFQ0094)the 1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(25HXJS028).
文摘Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hypertension(CSPH).However,there is still no research to explore the outcomes of laparoscopic versus open liver resection(OLR)in the specific patients with BCLC stage 0-A HCC and CSPH.Methods:Patients diagnosed with BCLC stage 0-A HCC and CSPH who underwent liver resection at West China Hospital of Sichuan University from February 2018 to December 2022 were analyzed.Demographic characteristics,pathological findings and postoperative outcomes were compared using propensity score matching(PSM).Long-term outcomes after surgery were analyzed using Kaplan-Meier analysis both before and after PSM.Results:A total of 409 patients,including 261 LLRs and 148 OLRs,were enrolled in this study.There were imbalances between the groups in baseline information.After 1:1 PSM,118 patients were included in each group with comparable baseline characteristics.Patients in the LLR group had significantly less intraoperative blood loss compared to those in the OLR group(median 223 vs.318 mL,P<0.001),and fewer postoperative complications(33.9%vs.57.6%,P<0.001),including lower rates of postoperative liver decompensation(16.9%vs.28.0%,P=0.043),postoperative ascites(18.6%vs.31.4%,P=0.024)and pulmonary infections(12.7%vs.29.7%,P=0.001).The long-term follow-up showed that overall survival(P=0.154)and recurrence-free survival(P=0.376)were comparable between the two groups.In subgroup analysis,patients with PLT≤75×10^(9)/L suffered more postoperative liver decompensation(PLD)and ascites than patiens with PLT>75×10^(9)/L.Conclusions:Compared with OLR,LLR had less intraoperative blood loss,fewer postoperative complications and comparable oncological outcomes for patients with BCLC stage 0/A HCC and CSPH.
文摘Non-cirrhotic portal hypertension(PHT)accounts for about 20%of all PHT cases,portal vein thrombosis(PVT) resulting in cavernous transformation being the most common cause.All known complications of PHT may be encountered in patients with chronic PVT.However,the effect of this entity on the biliary tree and pancreatic duct has not yet been fully established.Additionally,a dispute remains regarding the nomenclature of common bile duct abnormalities which occur as a result of chronic PVT.Although many clinical reports have focused on biliary abnormalities,only a few have evaluated both the biliary and pancreatic ductal systems.In this review the relevant literature evaluating the effect of PVT on both ductal systems is discussed,and findings are considered with reference to results of a prominent center in Turkey,from which the term"portal ductopathy"has been put forth to replace"portal biliopathy".
文摘Portal hypertension is a critical determinant of prognosis in chronic liver disease and a key factor in evaluating candidates for liver transplantation.Traditional methods such as hepatic venous pressure gradient(HVPG)measurement have long been considered the gold standard for assessing portal pressure.However,these methods are invasive and carry procedural limitations.Recent advances in endoscopic ultrasound(EUS)-guided techniques have emerged as promising alternatives,offering direct and minimally invasive assessment of portal pressure.EUS-guided portal pressure gradient measurement enables real-time evaluation of haemodynamic through direct access to the portal system.This technique has shown to be as accurate as HVPG,and it has some extra benefits,like the ability to take liver biopsies and check collateral circulation all at the same time.Despite these benefits,the technique poses challenges such as operator dependence,proce-dural complexity,and limited standardization across centres.This minireview highlights the evolution of portal pressure measurement,focusing on the potential of EUS-guided techniques in pre-transplant assessment,risk strati-fication,and monitoring therapeutic outcomes.Furthermore,it discusses the technical challenges,clinical implications,and future directions for integrating these innovations into routine practice.Advances in portal pressure measurement hold significant promise for enhancing decision-making and outcomes in liver transplantation.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is contraindicated for patients with cavernous transformation of the portal vein(CTPV)due to high surgery-related mortality risk.However,surgically assisted TIPS(SATIPS)can significantly reduce the risk.AIM To evaluate the clinical efficacy of SATIPS,this study was conducted.METHODS One hundred and seven patients with CTPV and esophagogastric variceal bleeding were recruited from January 2023 to December 2024.The patients were recruited from three different hospitals.Overall,54 patients received SATIPS treatment(SATIPS group),while 53 patients did not receive SATIPS and underwent prophylactic endoscopic sclerosing ligation(control group).Subsequently,survival rates,incidence rates of gastrointestinal bleeding,incidence of hepatic encephalopathy rate,and the incidence of liver failure after treatment in both groups at 3 and 6 months were observed.RESULTS The survival rates for the SATIPS and control groups were 94.4%and 92.5%at 3 months(P value=0.72)and 94.4%and 73.6%at 6 months(P value=0.0051)respectively.The incidence of liver failure was 3.7%and 9.4%at 3 months(P value=0.26)and 3.7%and18.9%at 6 months(P value=0.016);the incidence of gastrointestinal bleeding was 5.6%and 37.7%at 3 months(P value<0.001)and 9.3%and 47.2%(P value<0.001)at 6 months;and the incidence of hepatic encephalopathy was 3.7%and 17.0%at 3 months(P value=0.026)and 7.4%and 26.4%at 6 months(P value=0.026)respectively.CONCLUSION For patients with CTPV,there were no optimal treatment.Regarding long-term efficacy,SATIPS can significantly reduce the rate of rebleeding,hepatic encephalopathy and liver failure,and is associated with better survival.
基金This study was financially supported by the Department of Science & Tech-nology, New Delhi, India.
文摘BACKGROUND: Non-cirrhotic portal hypertension is acommon cause of portal hypertension in developing coun-tries. To understand its etiopathogenesis we developed ananimal model by repeated portal endotoxemia inducedthrough the gastrosplenic vein.METHODS: Twenty-nine rabbits (1.5-2.0 kg) were divid-ed into control (group n = 13) and experimental ( groupn = 16) groups. Heat killed E. coli were injected throughan indwelling cannula into the gastrosplenic vein in pre-sensitized animals. The animals were sacriflced at 1, 3 and6 months.RESULTS: The mean portal pressure in group animalswas significantly (P < 0. 05) higher than in group at 1(17.5 ±3.4 vs 10.4±2.2 mmHg), 3 (17.8±1.3 vs7.2 +3.6mmHg), and 6 (19.8±3.1 vs 10.3±4.8 mmHg) months.Similarly, the mean splenic weight in group was signifi-cantly greater than in group (P <0.05). Histopathologi-cally, the spleen showed medullary congestion, hemosid-rin-laden macrophages and mild fibrosis. Histologically,the liver had normal parenchyma with mild portal lympho-cytic infiltrates and kupffer cell hyperplasia. No significantanomalies were detected by liver function tests.CONCLUSIONS: The rabbit model showed significantsplenomegaly with a persistent increase in portal pressureand mild fibrosis without hepatic parenchymal injury, quiteakin to non-cirrhotic portal fibrosis as seen in humans. Re-current intra-abdominal infection may play an importantrole in the pathogenesis of non-cirrhotic portal fibrosis.
文摘Portal hypertension(PH)is a major complication of chronic liver disease,often leading to serious clinical consequences such as variceal bleeding,ascites,and splenomegaly.The current gold standard for PH diagnosis,namely,hepatic venous pressure gradient measurement,is invasive and not widely available.Transient elastography has emerged as a non-invasive alternative for assessing liver stiffness(LS),and recent studies have highlighted the potential role of splenic stiffness(SS)in evaluating PH severity.This narrative review summarizes the available evidence on the utility of splenic transient elastography in assessing PH.We evaluated its diagnostic accuracy,technical challenges,and clinical applications,particularly in distinguishing between cirrhotic PH(CPH)and noncirrhotic PH(NCPH).A comprehensive literature search was conducted using the PubMed database,focusing on studies that assess splenic elastography in the diagnosis and prognosis of PH.This review compares splenic elastography with other non-invasive imaging modalities,including MR elastography and shearwave elastography.Additionally,we examined the role of SS using elastography in predicting the presence of esophageal varices and its potential impact on reducing the need for endoscopic screening.Studies have demonstrated that splenic elastography correlates well with PH severity,with cut-off values ranging between 45 kPa and 50 kPa for significant PH detection.Splenic elastography,when combined with platelet count and LS measurements,improves diagnostic accuracy and risk stratification for the occurrence of variceal bleeding.Despite its clinical promise,technical challenges such as patient positioning,body habitus,and probe selection remain key limitations.Notably,splenic elastography may be particularly useful in diagnosing NCPH,where LS remains normal but PH is present.Splenic transient elastography is a valuable adjunct in the non-invasive assessment of PH.Its ability to predict varices,differentiate between CPH and NCPH,and reduce unnecessary endoscopies suggests that it should be incorporated into routine hepatology practice.Future research should focus on refining SS cut-offs,evaluating its cost-effectiveness,and integrating splenic elastography into clinical guidelines for PH management.
文摘BACKGROUND The hepatosplenic schistosomiasis(HSS)with portal hypertension can cause vascular complications such as hepatopulmonary syndrome(HPS).HPS increases the risk of mortality in patients with cirrhosis;however,there is no data on the mortality of patients with HSS and HPS.AIM To perform a survival analysis of patients with HPS related to cirrhotic and non-cirrhotic(schistosomiasis)portal hypertension.METHODS From August 2023 to January 2024,medical records and the official mortality information service of 121 patients who participated in a cross-sectional study on HPS between 2010 and 2012 were analyzed.Survival curves were created using the Kaplan-Meier method,and comparisons were performed using the log-rank test.Cox regression models estimated the hazard ratios(HR).RESULTS Overall,data of 113 patients were analyzed;most(55.8%)had HSS and concomitant cirrhosis(HSS/cirrhosis).Meanwhile,HPS was present in 39(34.5%)patients.Death occurred in 65 patients[57.5%];95%confidence interval(CI):48%-67%.The average time to death was lower in those with HPS when compared to those without HPS(3.37 years vs 5.65 years;P=0.017).According to the cause of liver disease,patients with HSS/cirrhosis died earlier,and their risk of death was twice as high compared with patients with HSS without cirrhosis(HR:2.17;95%CI:1.3-3.60;P=0.003).Meanwhile,there were no differences when comparing the two groups with and without HPS(HR:1.01;95%CI:0.59-1.73;P=0.967).CONCLUSION Patients with HSS and concomitant cirrhosis had a lower survival rate,but there was no difference in survival regardless of the presence of HPS.
文摘Non-tumoral portal vein thrombosis(PVT)is a frequent and challenging complication in liver transplant candidates.The prevalence reaches up to 26%in patients with cirrhosis on a transplant waiting list.Its severity increases with liver disease progression and significantly impacts post-transplant outcomes.Advanced PVT increases postoperative mortality to 30%.Effective management requires a multidisciplinary approach,especially in advanced cases.Preoperative strategies emphasize anticoagulation with low molecular weight heparin,while interventional radiology,including transjugular intrahepatic portosystemic shunts,offers alternatives in some cases.Intraoperatively,management is guided by PVT classification systems,ranging from thrombectomy and portal vein reconstruction to non-physiological reconstructions in complex cases.This manuscript explores the management of PVT in liver transplantation candidates,discusses strategies to optimize outcomes,and presents our institutional protocol for addressing this high-risk condition.
基金Supported by the Postgraduate Research and Practice Innovation Program of Jiangsu Province,No.SJCX24_2067Chen Xiao-Ping Foundation for the Development of Science and Technology of Hubei Province,No.CXPJJH123009-079.
文摘Portal vein thrombosis(PVT)is one of the most common serious complications in patients with liver cirrhosis.The occurrence of PVT not only aggravates the condition of liver cirrhosis but can also cause several serious complications,such as portal hypertension,esophagogastric variceal bleeding,and refractory ascites.All these factors have a serious impact on patients’quality of life and prognosis.This article evaluates the current evidence on the management of PVT in cirrhosis and explores the role of direct oral anticoagulants,but data on individualized anticoagulation strategies are limited and lacking for the treatment of PVT in cirrhosis,and it is hoped that it will inform a broad range of clinicians on the treatment of cirrhosis combined with PVT.
基金Supported by Quebec Health Research Fund Clinician Research Scholars Junior 1,No.350546.
文摘Clinically significant Portal hypertension(PH),defined by a hepatic venous pressure gradient(HVPG)greater than 10 mmHg,is a key predictor of decompensation events in cirrhosis,leading to variceal hemorrhage,ascites,and hepatic encephalopathy.This narrative review explores the pathophysiology of PH in cirrhosis,evaluates diagnostic methods for identifying clinically significant PH(CSPH),and discusses guideline-driven strategies to prevent initial and further decompensation.While HVPG remains the gold standard for diagnosing CSPH,non-invasive tools such as liver stiffness measurement and spleen stiffness measurement are increasingly used for initial risk stratification.The combined use of these tools reduces the proportion of patients in the diagnostic"grey zone".Endoscopic ultrasound-guided portal pressure gradient is an emerging diagnostic tool that requires further validation.Non-selective beta-blockers are the cornerstone of primary prophylaxis for decompensation,and their combination with endoscopic variceal ligation is the first-line therapy for secondary prophylaxis of recurrent esophageal variceal bleeding.Statins show promise in reducing PH and preventing decompensation while further studies are still needed.This review also discusses the indications for preemptive transjugular intrahepatic portosystemic shunt and its role in managing refractory ascites and variceal bleeding.
文摘Liver-directed therapies such as resection,ablation,and embolization offer potentially curative options for patients with primary and metastatic liver tumors as part of multidisciplinary oncology care.However,these treatments pose significant hepatic decompensation risks,particularly with underlying liver disease and chemotherapy-associated steatohepatitis.Accurate assessment of liver function and portal hypertension(PH)is critical for candidate selection.While Child-Pugh score and model for end-stage liver disease are commonly used,they have substantial limitations.Hepatic venous pressure gradient(HVPG)measurement remains the gold standard for assessing PH but is invasive and not widely available.Endoscopic ultrasound(EUS)guided portal pressure gradient(PPG)measurement has emerged as a promising minimally invasive alternative.EUSPPG demonstrates excellent technical success rates,safety profile,and correlation with HVPG in early studies.By providing direct portal pressure measurement,EUS-PPG offers several advantages over existing methods for prognostication and risk stratification prior to liver-directed therapies,particularly in detecting presinusoidal hypertension.Furthermore,it has potential applications in assessing response to neoadjuvant treatments and guiding adjuvant therapies.However,research is needed to validate its predictive performance and cost-effectiveness in larger prospective cohorts and to establish its accuracy compared to non-invasive assessment of liver function.
文摘Idiopathic portal hypertension is one of the interesting causes of portal hypertension. Even in very developed medical centers, this disorder is still one of the most important misdiagnoses of clinical practice. To inexperienced physicians, presenting esophageal varices and upper gastrointestinal bleeding usually prompt an unfortunate diagnosis of cirrhosis. A heterogenous clinical presentation and progression of this disorder should be recognized by physicians, and management should be directed towards some specific problems confined to this disorder. Although a genetic basis and other factors are implicated in its pathogenesis, exact underlying mechanism(s) is (are) unknown. In this review, we discuss the heterogeneity of idiopathic portal hypertension, its etiopathogenesis, clinical presentation and management issues. With the expectation of an excellent prognosis, a practicing gastroenterologist should be aware that "not all varices mean cirrhosis".
文摘Portal vein embolization(PVE)is currently considered the standard of care to improve the volume of an inadequate future remnant liver(FRL)and decrease the risk of post-hepatectomy liver failure(PHLF).PHLF remains a significant limitation in performing major liver surgery and is the main cause of mortality after resection.The degree of hypertrophy obtained after PVE is variable and depends on multiple factors.Up to 20%of patients fail to undergo the planned surgery because of either an inadequate FRL growth or tumor progression after the PVE procedure(usually 6-8 wk are needed before surgery).The management of PVE failure is still debated,with a lack of consensus regarding the best clinical strategy.Different additional techniques have been proposed,such as sequential transarterial chemoembolization followed by PVE,segment 4 PVE,intra-portal administration of stem cells,dietary supplementation,and hepatic vein embolization.The aim of this review is to summarize the up-to-date strategies to overcome such difficult situations and discuss future perspectives on improving FRL hypertrophy.
基金Supported by Shaanxi Provincial Social Development Fund,No.2024SF-YBXM-140.
文摘BACKGROUND Post-hepatectomy liver failure(PHLF)after liver resection is one of the main complications causing postoperative death in patients with hepatocellular carcinoma(HCC).It is crucial to help clinicians identify potential high-risk PHLF patients as early as possible through preoperative evaluation.AIM To identify risk factors for PHLF and develop a prediction model.METHODS This study included 248 patients with HCC at The Second Affiliated Hospital of Air Force Medical University between January 2014 and December 2023;these patients were divided into a training group(n=164)and a validation group(n=84)via random sampling.The independent variables for the occurrence of PHLF were identified by univariate and multivariate analyses and visualized as nomograms.Ultimately,comparisons were made with traditional models via receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).RESULTS In this study,portal vein width[odds ratio(OR)=1.603,95%CI:1.288-1.994,P≤0.001],the preoperative neutrophil-to-lymphocyte ratio(NLR)(OR=1.495,95%CI:1.126-1.984,P=0.005),and the albumin-bilirubin(ALBI)score(OR=8.868,95%CI:2.144-36.678,P=0.003)were independent risk factors for PHLF.A nomogram prediction model was developed using these factors.ROC and DCA analyses revealed that the predictive efficacy and clinical value of this model were better than those of traditional models.CONCLUSION A new Nomogram model for predicting PHLF in HCC patients was successfully established based on portal vein width,the NLR,and the ALBI score,which outperforms the traditional model.
基金Supported by Clinical Research Center for Hepatopathy and Intestinal Diseases of Fujian Province,No.2023GBYJ-YL-1.
文摘In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following transjugular intrahepatic portosystemic shunt(TIPS)and the implications for understanding the mechanisms,diagnosis,and treatment.By comparing the gut microbiota composition and dynamic changes before and after TIPS in patients with and without hepatic encephalopathy,the authors found an increase in non-probiotic bacteria in those who developed hepatic encephalopathy post-TIPS,with Morganella species present only in the hepatic encephalopathy group.The gut microbiota changes post-TIPS among patients without the occurrence of hepatic encephalopathy suggest potential therapeutic benefits through prophylactic microbiome therapies.Furthermore,the specific gut microbiota alterations may hold promise to predict the risk of hepatic encephalopathy in individuals undergoing TIPS for HBVrelated PH.Despite these promising findings,future studies are needed to address limitations,including a small sample size,a relatively short evaluation period for gut microbiota alterations,the absence of data on dynamic alterations in gut microbiota post-TIPS and their correlation with blood ammonia levels,and the lack of validation in animal models.In conclusion,Zhao et al's study has shed new light on the link of gut microbiota with post-TIPS hepatic encephalopathy,potentially through the intricate gut-liver axis,and has important clinical implications for improving the management of patients with HBV-related PH.
基金Projects(2022YFB4301201-02,2023YFB4302502-02)supported by the National Key R&D Program of ChinaProjects(52372369,52302447,52388102)supported by the National Natural Science Foundation of China。
文摘To address the severe aerodynamic effects caused by a 600 km/h superconducting maglev train passing through a tunnel at full speed,this study systematically investigates the coupled influence of auxiliary facility parameters including the shaft(location L,cross sectional dimension W,height h),tunnel portal(cross sectional area S),and openings(spacing D,side length F)on the evolution of tunnel aerodynamic effects.By integrating three dimensional unsteady flow field numerical simulations with a dynamic model testing system,the research notably reveals the regulatory mechanisms of these parameters on the evolution characteristics of the initial compression wave pressure gradient and the multi peak structure of micro-pressure waves.The results show that shaft parameters significantly affect the initial compression wave.Both the wave amplitude and gradient exhibit a linear negative correlation with cross sectional dimension W and a linear positive correlation with location L,while demonstrating a nonlinear relationship with height h,the amplitude follows a cubic polynomial trend,and the gradient initially increases before plateauing.Under the configuration W=8 m,L=50 m,and h=20 m,substantial reductions in both compression wave amplitude and gradient were achieved.The portal cross sectional area S shows a"U-shaped"relationship with the compression wave gradient,with the maximum gradient reduction of 53.24%occurring at S=210 m^(2),a result comparable to that achieved with optimized opening parameters(D=15 m,F=3.5 m,53.96%).Regarding micro-pressure waves,the amplitude measured 20 m from the tunnel exit shows a linear positive correlation with shaft parameters L and W,while the influence of h saturates beyond 50 m.Reductions exceeding 54%were achieved with portal parameters,either at S=210 m^(2) or using the optimized opening configuration.Furthermore,micro-pressure waves near the portal exhibit a consistent dual peak structure:the first peak originates from the train entry compression wave,and the second results from further wave compression after tunnel exit.The opening location governs selective peak regulation openings near the portal entrance primarily suppress the first peak with minimal impact on the second,whereas centrally located openings reduce the first peak but can amplify the second by up to 3%.Based on these insights,an optimized parameter configuration is proposed:a shaft with a cross-sectional dimension≥8 m located 50 m from the portal,a portal cross sectional area of 210 m^(2),and openings spaced at 15 m intervals.This configuration can reduce the initial compression wave gradient by over 50%.The results provide a theoretical foundation for controlling aerodynamic effects of superconducting maglev train.
基金Supported by the National Natural Science Foundation of China,No.81970533the Natural Science Foundation of Shandong Province,No.ZR2022ZD21.
文摘Esophagogastric variceal bleeding is a common and severe complication of cirr-hotic portal hypertension.Hepatic venous pressure gradient measurement and esophagogastroduodenoscopy are the diagnostic gold standards for portal hyper-tension and esophagogastric variceal bleeding,respectively.With advancements in artificial intelligence in medicine,non-invasive diagnostic methods are in-creasingly replacing traditional invasive procedures,permitting more rational and personalized patient care.This review summarizes the formation and diagnosis of portal hypertension,as well as the primary prophylaxis,secondary prophylaxis,and management of acute esophagogastric variceal bleeding.This study also highlights the latest progress in artificial intelligence in the diagnosis and treat-ment of portal hypertension and esophagogastric varices.
文摘BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated with PH-PVT.METHODS Medical records of patients who underwent hepatic resection for various diseases between February 2014 and December 2023 at Beijing Tsinghua Changgung Hospital affiliated with Tsinghua University(Beijing,China)were retrospectively reviewed.The patients were divided into a PH-PVT group and a non-PH-PVT group.Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PH-PVT.RESULTS A total of 1064 patients were included in the study cohort,and the incidence and mortality rates of PH-PVT were 3.9%and 35.7%,respectively.The median time from hepatectomy to the diagnosis of PH-PVT was 6 days.Multivariate analysis revealed that hepatectomy combined with pancreaticoduodenectomy(HPD)[odds ratio(OR)=7.627(1.390-41.842),P=0.019],portal vein reconstruction[OR=6.119(2.636-14.203),P<0.001]and a postoperative portal vein angle<100°[OR=2.457(1.131-5.348),P=0.023]were independent risk factors for PH-PVT.Age≥60 years[OR=8.688(1.774-42.539),P=0.008]and portal vein reconstruction[OR=6.182(1.246-30.687),P=0.026]were independent risk factors for mortality in PH-PVT patients.CONCLUSION Portal vein reconstruction,a postoperative portal vein angle<100°and HPD were independent risk factors for PHPVT.Age≥60 years and portal vein reconstruction were independent risk factors for mortality in PH-PVT patients.
