肝移植（LT）是门静脉高压症（PHT）的最终治疗手段。PHT时门静脉血栓（PVT）形成、门静脉海绵样变(CTPV)、脾动脉窃血综合征（SASS）等病理生理改变对移植肝血供有重要影响，不仅大大增加LT手术风险，还有可能影响移植肝的长期生存。术前要合理选择适应证，最好预备多种血管重建方案。术中取栓和寻找可利用的内脏静脉是关键，尽可能控制创伤面和缩短手术时间是减少围手术期并发症和死亡的最重要的明智之举。而对门静脉和肝动脉灌注的监测应贯穿LT前后全过程。本文就PHT时门静脉与肝动脉的常见病理改变、形成机制、对LT术中术后近远期影响及对策，进行梳理与探讨。

Liver transplantation (LT) is the ultimate treatment for portal hypertension (PHT). Pathophysiological changes such as portal vein thrombosis (PVT), cavernous transformation of portal vein (CTPV) and splenic artery steal syndrome (SASS) during PHT exert significant impact on the blood supply of liver allograft, which not only significantly increases the risk of LT, but also probably affects the long-term survival of liver allograft. Preoperatively, surgical indications should be selected reasonably, and it is recommended to prepare multiple regimens for vascular reconstruction. Intraoperative embolectomy and identifying usable veins are key procedures. Controlling wound surface and shortening the operation time play crucial roles in reducing perioperative complications and death. The monitoring of portal vein and hepatic artery perfusion should be performed throughout the whole process before and after LT. In this article, common pathological changes of portal vein and hepatic artery during PHT, underlying mechanism, short-term and long-term effects on intraoperative and postoperative periods of LT and corresponding countermeasures were illustrated and discussed.