门静脉高压症（PH）主要由肝硬化引起，临床表现为食管胃静脉曲张（GOV）、腹水、脾亢及肝性脑病等，是肝硬化失代偿的重要标志，预后差。PH始动因素为肝内血流阻力增加，继而导致内脏高动力循环及门-体侧枝循环形成。随着病情进展，可出现门静脉海绵样变及门静脉血栓（PVT），进一步加剧肝灌注不足。肝静脉压力梯度（HVPG）是诊断和评估肝硬化PH严重程度的金标准。HVPG≥10 mmHg（1 mmHg=0.133 kPa）为临床显著性PH阈值，≥12 mmHg显著增加出血风险，≥16 mmHg死亡风险增加，HVPG≥20 mmHg则食管胃静脉曲张破裂（EVB）治疗失败和死亡的风险增加。治疗策略强调分期施治与多学科协作。代偿期重在病因治疗及非选择性β受体阻滞剂（NSBB）或内镜套扎的一级预防。急性EVB期首选血管活性药物联合内镜治疗，失败者及时行经颈静脉肝内门体分流术（TIPS）。二级预防推荐NSBB联合内镜或TIPS。对于反复出血且肝功能尚可者，腹腔镜脾切断流术在改善肝功能及预防再出血方面具有独特优势。终末期则需TIPS桥接或行肝移植。PH治疗需依据分期个体化选择，兼顾降低门静脉压力、防治出血及保护肝功能，其中抗凝与PVT管理是保持治疗衔接性的关键。

Portal hypertension (PH) is mainly caused by liver cirrhosis, manifested with gastroesophageal varices (GOV), ascites, hypersplenism and hepatic encephalopathy, etc. PH is a vital sign of decompensated liver cirrhosis and yields poor prognosis. The initial factor of PH is the increase in blood flow resistance in the liver, thereby leading to the formation of visceral hyperdynamic circulation and portosystemic shunts. With the progression of disease, cavernous transformation of portal vein thrombosis (PVT) may occur, which further aggravates hepatic perfusion insufficiency. Hepatic venous pressure gradient (HVPG) is the gold standard for diagnosing and evaluating the severity of PH in liver cirrhosis. HVPG≥10 mmHg (1 mmHg=0.133 kPa) is the clinically significant PH threshold, ≥12 mmHg significantly increases the risk of bleeding, ≥16 mmHg increases the risk of death, and HVPG≥20 mmHg increases the risk of treatment failure and death of esophageal varices bleeding(EVB). The treatment strategy emphasizes staged treatment and multidisciplinary team cooperation. During the compensatory stage, extensive attention is paid to etiological treatment and primary prevention of non-selective β-blocker (NSBB) or endoscopic ligation. The combination of vasoactive drugs and endoscopy is the first choice for acute EVB, and transjugular intrahepatic portosystemic shunt (TIPS) is chosen for patients with treatment failure. NSBB combined with endoscopy or TIPS is recommended for secondary prevention. For patients with recurrent bleeding and acceptable liver function, laparoscopic splenectomy has unique advantages in improving liver function and preventing rebleeding. TIPS bridging or liver transplantation is recommended at the end stage. Individual treatment options should be chosen based on the staging of PH. Efforts should be made to comprehensively consider reducing portal pressure, preventing bleeding and protecting liver function. Anticoagulation and PVT management are the keys to maintaining the continuity of treatment.