Retrospective Study Of Portal Vein Thrombosis After Splenectomy Combined With Pericardial Devascularization

Background Cirrhosis is a common clinically chronic liver disease characterized by diffuse fibrosis,pseudolobule formation and regenerative nodule formation.Hepatitis B virus(HBV)infection and alcoholic liver disease are the most important causes of cirrhosis in China.More than 10 million patients die from cirrhosis every year in the world.Among them,the number of deaths due to cirrhosis in China accounts for more than half of the world s related deaths,and that cirrhosis and portal hypertension(PHT)cause esophageal varices rupture is the main cause of death.At present,the most common method for treating patients with cirrhosis and portal hypertension,especially those with esophageal and gastric varices bleeding,is splenectomy combined with pericardial devascularization(in short SPD).It is that the hemostasis rate of patients with hemorrhage caused by esophageal varices bleeding is almost 100%,which can significantly reduce the incidence of hepatic encephalopathy and maintain the stability of hepatic blood flow.Portal vein thrombosis(PVT)refers to the partial or complete formation of thrombus in the portal vein and its left and right branches,splenic veins,superior and inferior mesenteric veins,and it is a serious concomitant spleen incision in patients with cirrhosis and portal hypertension.PVT affect the prognosis of patients and accelerate the progression of cirrhosis in patients.PVT clinical manifestations vary,acute PVT can be characterized by sudden severe abdominal pain,refractory ascites,gastrointestinal bleeding and melena,severe cases of intestinal necrosis,diffuse peritonitis,septic shock and even death.Chronic PVT usually has no obvious symptoms and is easily overlooked,but it may increase the incidence of hepatic encephalopathy due to the progressive increase of portal pressure.According to statistics,the incidence of postoperative portal vein thrombosis is as high as 0.6%-26%,so it is of great clinical significance to fully understand PVT and its early diagnosis and treatment.This study collected the clinical data of patients who underwent concurrent surgery at the Qilu Hospital of Shandong University from April 2010 to December 2016.The cases were followed up for 3 months,this research is combined with the latest literature for analysis and summary to deepen the understanding of PVT,and this will provide clinical advice for the prevention of PVT in patients undergoing SPD.Objective To collect the clinical data of 87 patients with cirrhosis and PHT treated with SPD in Qilu Hospital of Shandong University(in our district)from April 2010 to December 2016.To explore the possible risk factors of portal vein thrombosis after SPD.To improve the understanding of such diseases and reduce its clinical incidence with early intervention,.Methods A total number of 87 cases were included in the study.All the surgical methods were SPD.The gender,age,preoperative platelet value,postoperative platelet maximum value,diabetes,infection,antiplatelet drugs and/or anticoagulants were inc uded.Results 87 cases were divided into thrombosis group and non-thrombosis group.There were 17 cases in the thrombosis group,8 male patients and 9 female patients.In the non-thrombosis group,there were 38 male patients and 32 female patients.Of the 8 male patients diagnosed,1 patient underwent abdominal CT scan,4 patients underwent abdominal CT scan,and 3 patients underwent abdominal ultrasound;of the 9 confirmed female patients,3 patients underwent abdominal CT scan,1 patient underwent abdominal MRI,1 case was abdominal CT enhanced scan,and 4 cases were confirmed by abdominal ultrasound.The patients were aged between 30 and 69 years old with an average age of 49.83 ± 9.62 years.The average age of patients in the thrombosis group was 50.41±9.25 years old,and the average age of patients in the non-thrombosis group was 49.6919.70 years old.In the liver function classification,15 patients in the thrombosis group had a Child-Pugh grade of grade A,2 patients had a Child-Pugh grade of grade B,and 63 patients with a non-thrombosis group had a Child-Pugh grade of grade A,and 7 patients had a Child-Pugh grade of grade B.The preoperative platelet count of the 87 patients was(57.36±31.04)*10^9/L,and the mean platelet count preoperation was(56.54±41.41)*10^9/L in the thrombosis group.The value is(57.81±28.29)*10^9/L.In the thrombosis group,15 patients with hepatitis B,3 patients with diabetes,4 patients with gallstones with chronic cholecystitis;62 patients with non-thrombosis group with hepatitis B,12 with diabetes,8 Cases with gallstones with chronic cholecystitis.In these two groups,the calculated P values were greater than 0.05 in terms of gender,age,preoperative platelet minimum,liver function Child-Pugh classification,and other combined diseases,which means not statistically significant.The highest count of platelet counts in 87 cases was(399.23±188.52)*10^9/L,and the average platelet count(488.35±178.05)*10^9/L in the thrombosis group was the highest in the non-thrombosis group.The platelet value was(377.59±184.59)*10^9/L,and the difference was statistically significant.Among the cases with the highest platelet value less than 300*10^9/L after operation,2 patients in the thrombosis group did not receive antiplatelet and/or anticoagulant therapy,and 1 patient underwent antiplatelet and/or anticoagulant therapy;Sixteen patients in the thrombosis group did not receive antiplatelet and/or anticoagulant therapy,and 10 patients underwent antiplateiet and/or anticoagulant therapy.The difference was not statistically significant.In cases with platelets exceeding 300*10^9/L,4 patients in the thrombosis group did not receive antiplatelet and/or anticoagulant therapy,10 patients underwent antiplatelet and/or anticoagulant therapy,and 2 patients in the non-thrombosis group.For example,antiplatelet and/or anticoagulant therapy were not performed,and 42 patients underwent antiplatelet and/or anticoagulant therapy.The difference was statistically significant.In 63 patients who underwent antiplatelet and/or anticoagulant therapy,2 patients in the thrombosis group were treated with salvianolate,3 patients with aspirin,5 patients with low molecular weight heparin and 1 patient with aspirin +dipyridamole;In the non-thrombosis group,6 cases were treated with salvianolate,25 cases of aspirin,12 cases of low molecular weight heparin and 7 cases of aspirin +dipyridamole.In the thrombosis group,7 patients had higher white blood cell counts than normal values;10 patients in the non-thrombosis group had higher white blood cell counts than normal values,and the difference was statistically significant.Conclusions PVT in patients with SPD has no relationship with age,gender,preoperative clinical manifestations and signs,preoperative platelet levels,diabetes,liver Child-Pugh classification and other factors.Postoperative platelet elevation is a high risk factor for PVT formation.Postoperative attention should be paid to the patient's platelet level,early antiplatelet and/or anticoagulant therapy,close attention to the patient's condition,and timely imaging examination to rule out the presence of portal vein,thrombus.Postoperative infection may induce the occurrence of PVT.Postoperative attention should be given to patients with liver protection,blood sugar control and anti-infection treatment,and try to avoid factors that may cause portal vein thrombosis.