Analysis Of Risk Factors For Postoperative Portal Vein Thrombosis After Laparoscopic Splenectomy Or Combined Devascularization

Objective:Portal vein system thrombosis(PVST)is a frequent and potentially life-threatening complication after laparoscopic splenectomy(LS)in cirrhotic patients with hypersplenism.The mechanisms and risk factors of PVST are poorly understood.This study investigated risk factors for PVST following LS in cirrhotic patients with hypersplenism.Methods:A total of 62 patients with secondary hypersplenism due to cirrhotic portal hypertension was admitted to Clinical Medical College of Yangzhou University,who undergoing successfully LC between January 2013 and April 2014 were retrospectively reviewed and analyze.Based on whether or not the patients had PVST on postoperative day(POD)7,the patients were categorized into non-PVST and PVST groups.Fifteen perioperative variables were analyzed in both groups.Results:PVST increased in size in 24/56(42.9%)of 56 patients after LS on POD 7.Using monofactorial analysis for each variable between the two groups,the age and portal vein diameter in PVST group were higher and velocity of portal blood flow in PVST group were lower than that in non-PVST group,and the difierences were statistically significant(all P<0.05).From a small value of these significant variables to a large one,Bivariate correlation analysis was performed for the relationship between these significant variables and occurrence of PVST on POD 7.According to the correlation coefficient,the most significant levels wereage>50 years and a portal vein diameter>13 mm.The most significant levels of significant variables were regarded as independent variables,and PVST on POD 7 was regarded as the dependent variable.Logistic multivariable regression showed that age>50 years(relative risk,20.127;95%confidence interval,3.598-112.578;P=0.001)and portal vein diameter>13 mm(relative risk,35.796;95%confidence interval,4.534-282.614;P = 0.001)were significant independent risk factors for PVST.Conclusion:A portal vein diameter>13 mm and age>50 years are independent risk factors for PVST after LS in cirrhotic patients with hypersplenism due to portal hypertension.Introduction:Portal vein system thrombosis(PVST)is an alarming and potentially life-threatening complication of laparoscopic splenectomy and azygoportal.disconnection(LSD).The objective of this study was to investigate negative and positive predictors of PVST after LSD in patients receiving anticoagulant regimens with aspirin or warfarin.Methods:Seventy-five consecutive patients who underwent LSD from 2013 to 2014 were retrospectively reviewed.Patients received anticoagulant regimen with warfarin(n=35)or aspirin(n=40)according to individual preference.International normalized ratio(INR)and the incidence of PSVT were compared in patients received anticoagulant regimen with warfarin or aspirin on postoperative days(POD)7,30,and 90,and factors associated with PVST at these time points were determined by univariate and logistic multivariable regression analyses.Results:Portal vein diameter was an independent negative predictor of PVST on PODs 7,30,and 90.Anticoagulation with warfarin was an independent positive predictor of PVST on PODs 30 and 90,and INR was an independent positive predictor of PVST on POD 90.Dynamic changes in the incidence of PVST on the day of admission and on PODs 7,30,and 90 differed significantly between the warfarin and aspirin groups(P = 0.002).No patient experienced perioperative bleeding.Conclusions:Portal vein diameter was an independent negative predictor,while anticoagulation therapy with warfarin and INR were independent positive predictors,of PVST after LSD.Early anticoagulation with warfarin is safe and effective for the prevention of PVST after LSD.