肝硬化脾切除术后门静脉系统血栓形成的危险因素分析*

doi:10.3969/j.issn.1672-5069.2019.05.024

Abstract

Abstract: Objective To analyze the risk factors of portal vein thrombosis （PVT） after splenectomy in patients with liver cirrhosis and portal hypertension. Methods 94 patients with liver cirrhosis and portal hypertension were admitted to our hospital between January 2015 to June 2018,and all the patients received splenectomy and pericardial devascularization. Color Doppler ultrasonography was carried out for PVT. Multivariate Logistic regression analysis was applied to reveal the risk factors for postoperative PVT. Results 30 patients were found to have the PVT by ultrasonography one month after the operation,and the proportion of ascites in patients with PVT was significantly higher than that in non-PVT group [56.7% vs. 32.8%,P<0.05],the spleen thickness was significantly greater than that in non- PVT group [（75.8±9.4） mm vs. （69.1±8.8） mm,P<0.05],the spleen volume was significantly larger than that in non-PVT group [（141.7±18.1） mm2 vs. （126.8±17.2） mm2,P<0.05],the portal vein diameter was significantly wider than that in non-PVT group [（16.2±2.1） mm vs.（14.1±1.9） mm,P<0.05],the portal vein velocity was significantly slower than that in non-PVT group [（12.2±1.5） cm/s vs. （14.6±1.6） cm/s,P<0.05],the proportion of patients had having low molecular weight dextran or low molecular weight heparin therapy was significantly lower than that in non-PVT group （P<0.05）;the Logistic regression analysis showed that absence of anti-coagulative therapy （OR=0.503,P=0.023）,slowed portal vein velocity（OR=0.491,P=0.014）,increased spleen volume （OR=1.872,P=0.044） and increased portal vein diameter （OR=1.982,P=0.021） were the independent risk factors for postoperative PVT formation in patients with liver cirrhosis after splenectomy. Conclusion s The clinicians must take the risk factors of PVT formation into consideration in dealing with portal hypertension by splenectomy and devascularization,and give the appropriate prophylactic management.

Key words: Liver cirrhosis, Splenectomy, Pericardial devascularization, Portal vein thrombosis, Risk factors

Xu Qilin, Hao Shaohuan, Ran Bo. Risk factors of portal vein thrombosis after splenectomy in patients with liver cirrhosis and portal hypertension[J]. Journal of Practical Hepatology, 2019, 22(5): 708-711.

References

[1] Fukui H,Saito H,Ueno Y,et al.Evidence-based clinical practice guidelines for liver cirrhosis 2015. J Gastroenterol,2016,51(7):629-650.
[2] Takuma Y,Nouso K,Morimoto Y,et al.Portal hypertension in patients with liver cirrhosis:Diagnostic accuracy of spleen stiffness. Radiology,2016,279(2):609-619.
[3] Kitai S,Kudo M,Nishida N,et al.Survival benefit of locoregional treatment for hepatocellular carcinoma with advanced liver cirrhosis. Liver Cancer,2016,5(3):175-189.
[4] Zhang J Y,Wang Y B,Gong J P,et al.Postoperative anticoagulants in preventing portal vein thrombosis in patients undergoing splenectomy because of liver cirrhosis:A Meta-analysis. Am Surg,2016,82(12):1169-1177.
[5] Jiang G Q,Xia B L,Chen P,et al.Anticoagulation therapy with Warfarin versus low-dose aspirin prevents portal vein thrombosis after laparoscopic splenectomy and azygoportal disconnection. J Laparoendosc Adv Surg Tech A,2016,26(7):517-523.
[6] Ghabril M,Agarwal S,Lacerda M,et al.Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation:Analysis of risk factors and outcomes for portal vein thrombosis in waitlisted patients. Transplantation,2016,100(1):126-133.
[7] Tarantino L,Busto G,Nasto A,et al.Percutaneous electrochemotherapy in the treatment of portal vein tumor thrombosis at hepatic hilum in patients with hepatocellular carcinoma in cirrhosis:A feasibility study. World J Gastroenterol,2017,23(5):906-918.
[8] Wu S,Wu Z,Zhang X,et al.The incidence and risk factors of portal vein system thrombosis after splenectomy and pericardial devascularization. Turk J Gastroenterol,2015,26(5):423-428.
[9] Xu M,Xue W,Ma Z,et al.Resveratrol reduces the incidence of portal vein system thrombosis after splenectomy in a rat fibrosis model. Oxid Med Cell Longev,2016,2016(12):1-7.
[10] Iida H,Aihara T,Ikuta S,et al.Predictive factors of portal vein thrombus following splenectomy in patients with severe cirrhosis. Hepatogastroenterology,2014,61(134):1552-1555.
[11] Kawanaka H,Akahoshi T,Itoh S,et al.Optimizing risk stratification in portal vein thrombosis after splenectomy and its primary prophylaxis with antithrombin III concentrates and danaparoid sodium in liver cirrhosis with portal hypertension. J Am Coll Surg,2014,219(5):865-874.
[12] Gelas T,Scalabre A,Hameury F,et al.Portal vein thrombosis after laparoscopic splenectomy during childhood. J Thromb Thrombol,2014,38(2):218-222.
[13] 韩建波,易永祥,丁海,等. 门静脉高压症脾切断流术后门静脉血栓的术前相关危险因素分析. 中华肝脏病杂志,2014,22(10):739-743.
[14] 刘熙瑞,刘连新. 肝硬化门静脉高压症脾切除术后门静脉血栓形成的研究进展. 中华消化外科杂志,2015,14(2):170-172.
[15] Jiang G Q,Bai D S,Chen P,et al.Risk factors for portal vein System thrombosis after laparoscopic splenectomy in cirrhotic patients with hypersplenism. J Laparoendosc Adv Surg Tech A,2016,26(6):419-423.
[16] Kinjo N,Kawanaka H,Akahoshi T,et al.Portal vein thrombosis in liver cirrhosis. World J Hepatol,2014,6(2):64-71.
[17] 王满才,田斌,王根年,等. 肝硬化脾切除术后门静脉血栓形成相关因素的Meta分析. 中华肝胆外科杂志,2014,20(12):855-861.
[18] Qi X,Li H,Liu X,et al.Novel insights into the development of portal vein thrombosis in cirrhosis patients. Expert Rev Gastroenterol Hepatol,2015,9(11):1421-1432.
[19] 臧立娜,邢慧慧,王嘉菲,等. 肝硬化并发门静脉血栓研究进展. 实用肝脏病杂志,2014(4):429-432.
[20] 吕少诚,顾万清. 肝硬化患者脾切除术后门静脉血栓的防治研究进展. 中华肝胆外科杂志,2015,21(1):59-62.
[21] 陆申新, 陈世耀. 抗凝治疗肝硬化患者并发门静脉血栓的循证医学证据. 实用肝脏病杂志,2016,19(5):624-628.
[22] Loss M,Lang S A,Uller W,et al.Combined surgical and interventional therapy of acute portal vein thrombosis without cirrhosis:A new effective hybrid approach for recanalization of the portal venous system. J Am Coll Surg,2014,218(3):79-86.
[23] Hongwei C,Zhang L,Maoping L,et al.Era of liver transplantation:combined anatomic splenectomy and anticoagulant therapy in prevention of portal vein thrombosis after splenectomy. Hepatogastroenterology,2014,62(138):405-409.
[24] Loffredo L,Pastori D,Farcomeni A,et al.Effects of anticoagulants in patients with cirrhosis and portal vein thrombosis:A systematic review and Meta-analysis. Gastroenterology,2017, 153(2):480-487.
[25] Yang S,He C,Fan X,et al.Early prophylactic anticoagulation via transjugular intrahepatic route for portal vein thrombosis after splenectomy in cirrhotic portal hypertension. J Vasc Int Radiol,2015,26(7):1009-1017.

Risk factors of portal vein thrombosis after splenectomy in patients with liver cirrhosis and portal hypertension

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