The Relationship Between The Degree Of Remission Of Esophageal Varices And The Changes Of Spleen After Rex Shunt And Construction Of The Prediction Model

ObjectiveTo explore the correlation between Esophageal Varices(EV)and changes in spleen size after Rex Shunt,and to develop a predictive model to provide a noninvasive detection model for evaluating the extent of esophageal varices after surgery.MethodsClinical data of children with CTPV who visited our hepatobiliary surgery department for Rex shunt from 2014-09 to 2021-12 were collected,and the general data of the children were statistically analyzed,and the children were grouped according to their postoperative EV,and the differences between the two groups were compared.The variables related to spleen size change were included in a multifactorial binary logistic regression model,and the prediction model of moderate-to-severe EV risk after surgery was constructed and the area under the receiver operating characteristic curve(ROC)was used to verify the prediction efficiency of the model.Internal validation of the model was performed by Bootstrap method to check the discrimination and calibration degree.ResultsA total of 121 children were included,including 75 males and 46 females,with a male-to-female ratio of 1.63:1,a mean age of 5.90+3.23 years(6 months-15years).and a mean follow-up time of 47.88+25.26 months(13-100 months).All children underwent smooth surgical procedures,and the postoperative portal venous pressure(PVP)was significantly lower than before(24.67+4.31mm Hg vs18.41+3.98mm Hg,P<0.01),postoperative white blood cell count,hemoglobin and platelet count were higher than before(white blood cell count:4.63+2.85 x10~9/L vs5.65+2.52x10~9/L,P<0.01;hemoglobin:97.08+18.88g/L vs 117.68+15.97g/L,P<0.01;platelet count:91.38+48.43x10~9/L vs 181.92+126.30x10~9/L,P<0.01),all within the normal range.Splenic length diameter(SD),splenic thickness(ST),and splenic volume(SV)were significantly reduced compared with those before surgery(P<0.01).Postoperative complete remission of esophageal varices accounted for 55.93%and partial remission 33.90%,with a remission rate of 89.83%.There were 18 cases(14.88%)of vascular complications,including 4 cases(3.31%)of bypass vessel embolism and 14 cases(11.57%)of anastomotic stenosis.4 children with thrombosis underwent Rex Shunt again,and all children with anastomotic stenosis had their symptoms relieved after balloon dilation,stent placement or conservative observation.2.Among 121 children,78 children with complete preoperative and postoperative ultrasound and gastroscopic data were included in this study,and were grouped according to their postoperative EV,55 in the no-mild group and 23 in the moderate-to-severe group.The differences between the two groups were not statistically significant in age,gender,degree of preoperative EV,and postoperative PVP,postoperative SD,postoperative ST,postoperative SV,and other factors;And statistically significant differences were found in vascular complications,bypass vessels,PVP difference,splenic thickness difference(STD),splenic length difference(SDD),splenic volume difference(SVD),and PLT/splenic length diameter(PLT/SD)(P<0.05),and the postoperative STD,SDD,and SVD were significantly lower in the moderate-to-severe EV group than in the no-mild EV group(P<0.05),and the incidence of vascular complications was significantly higher than in the no-mild EV(P<0.05).Spearman’s rank correlation coefficient was used to test the correlation between SDD,STD,SVD,PLT/SD and postoperative EV.The correlation coefficient of SDD was-0.443,p=0.000;the correlation coefficient of STD was-0.452,p=0.000;the correlation coefficient of SVD was-0.523,p=0.000,and the correlation coefficient of PLT/SD was-0.413,p=0.022,all of which were negatively correlated with postoperative EV.The ROC curves with postoperative EV were established using SDD,STD,and SVD alone as evaluation models,respectively,and the results showed that SVD had more excellent predictive ability with AUC=84.4%,95%CI72.3%-96.5%;STD was next with AUC-79.2%,95%CI 67.0%-91.4%;and finally SDD with AUC=77.4%,95%CI 64.5%-90.2%.SDD,STD,and SVD,after excluding covariance,were included in a multifactorial binary logistic regression analysis,using stepwise regression,to screen the variables,and the results showed that STD(OR=0.889,95%CI 0.811-0.975,P<0.05)、SVD(OR=0.989,95%CI 0.982-0.996,P<0.05)were independent risk factors for postoperative moderate-to-severe EV,and STD、SVD were protective factors.According to the results of logistic regression analysis,the final regression equation model obtained was:logit(P)=-STD×0.118-SVD×0.011+0.502,area under the ROC curve was 89.73%,95%CI 81.07%-98.39%,and the optimal threshold point was-0.952,and its specificity and sensitivity were 82.6%and 83.3%,respectively.The column line graph of the postoperative moderate-to-severe EV prediction model was plotted and internally validated,and the C-index was 0.897,with good discrimination;The calibration curve was used to evaluate the calibration of the column line graph,and it passed the calibration degree test.Conclusions:1.The change in size of the spleen correlates well with postoperative EV and can be used as its predictor;2.STD and SVD are independent risk factors for postoperative moderate-to-severe EV,and this model can well predict the occurrence of postoperative moderate-to-severe EV which can be used as a non-invasive means to detect EV.