| Objective: To investigate the possible risk factors for postoperative portal venous thrombosis(PVT)in patients after selective pericardial devascularization combined with splenectomy in the treatment of portal hypertension,and to provide reference for clinical evaluation and reduction of postoperative portal venous thrombosis(PVT)in patients after selective pericardial devascularization combined with splenectomy.Methods: Collect the clinical data of 86 patients with portal hypertension who were hospitalized from our hospital from January 2011 to December 2015.These patients was diagnosed as liver cirrhosis with portal hypertension combined with esophageal varices,also excluded the following cases: 1.Patients with cirrhosis complicated with hepatocellular carcinoma,gastric cancer,pancreatic cancer or other abdominal tumors,2.Diagnosed as portal venous thrombosis before the surgery,3.Patients with previous abdominal surgery,4.Patients with liver cirrhosis complicated with immune system diseases,5.Patients with liver cirrhosis complicated with hematological diseases,6.Patients with other organ dysfunction,intolerant surgery,7.Simply selective pericardial devascularization without splenectomy or simply splenectomy without selective pericardial devascularization,8.Patients died perioperatively,9.Patients do not cooperate with the treatment and follow-up survey.All cases were accepted selective pericardial devascularization combined with splenectomy.These patients were divided into postoperative portal venous thrombosis group and non-thrombosis group.The chi-square test was used to analyze the count data and the t-test was used to analyze the measurement data,in order to investigate the risk factors for postoperative portal venous thrombosis after selective pericardial devascularization combined with splenectomy.Results: Among the 86 patients,up to July 2016,the follow-up time was from 5 months to 61 months,the mean follow-up time was 26 months.There were 55 cases(64.0%)of males and 31 cases(36.0%)of females with an average age of 51.2 ± 1.19 years;65 cases(75.6%)of hepatitis B cirrhosis,12 cases(14.0%)of alcoholic cirrhosis,5cases(5.8%)of hepatitis B cirrhosis combined with alcoholic cirrhosis,2 cases(2.3%)of biliary cirrhosis,1 case(1.2%)of Caroli symdrone,1 case(1.2%)of autoimmune liver disease;and 35 cases(40.7%)of liver function Child A grade,48 cases(55.8%)of Child B grade,3 cases(3.5%)of Child C grade;after endoscopy,there were 4 cases(4.7%)of mild varicose veins,18 cases(20.9%)of moderate varicose veins,64 cases(74.4%)of severe varicose veins;2 cases(2.3%)were treated with endoscopic sclerotherapy before,2 cases(2.3%)were treated with endoscopic ligation,1 case(1.2%)was treated with embolization;8 cases(9.30%)were found hemorrhagic shock when sent to our hospital,4 cases(4.7%)received emergency surgery;The average portal vein diameter is13.69±0.28mm;the average spleen long diameter is172.27±1.27 mm.The average count of hemoglobin was 102.80 ± 2.54 g / L,the average preoperative platelet was 66.81 ±6.75 × 109 / L,the average platelet 1 day after operation was 99.33 ± 9.22 × 109 / L,the average platelet 1 week after operation was 345.02 ± 31.88 × 109 / L(72.0%);and there were 60 cases(69.8%)of open surgery,26 cases(30.2%)of endoscopic surgery,mean operation time was 223.44 ± 7.02 min,mean intraoperative bleeding was 460.47 ±48.93ml;postoperative portal venous thrombosis was found in 10 cases(11.6%)after operation;Univariate analysis showed that there was a significant difference between the thrombosis group and the non-thrombosis group(p <0.05).The average postoperative platelet was 66.81 ± 6.75 × 109 / L,the average postoperative day 1 was99.33 ± 9.22 × 109 / L,the average postoperative 1 week Platelet surgery(28.0%),mean operation time 223.44 ± 7.02 min,mean intraoperative bleeding 460.47 ± 48.93ml;postoperative portal venous thrombosis 10(72.0%),open surgery(11.6%).The univariate analysis showed that there was significant difference between the thrombosis group and the non-thrombosis group in whether received emergency operation and the portal vein diameter and the time of operation,and the difference was statistically significant(p<0.05).Multivariate analysis showed that there was significant difference between the thrombosis group and the non-thrombosis group in whether received emergency operation and portal vein diameter,and the difference was statistically significant(p<0.05).Incidence of postoperative Portal venous thrombosis was higher in patients who had portal vein diameter >13.5mm,and in patients who received emergency eperation.Conclusion: Whether received emergency operation and portal venous thrombosis were the independent risk factors for postoperative portal venous thrombosis. |
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