| Background:China is a big country of hepatitis B,and the number of HBV infections ranks first in the world for many years.Long-term chronic damage of the virus can cause cirrhosis of the liver.Esophageal variceal bleeding is the most serious and difficult complication of portal hypertension.Splenectomy combined with selective pericardial devascularization is the most common surgical treatment for portal hypertension.However,portal vein thrombosis(PVST)is one of the major postoperative complications.This study will meta-analyze the related factors of PVST after splenectomy and explore the related factors of portal vein thrombosis after splenectomy,in order to provide theoretical basis for early diagnosis and prevention of portal vein thrombosis after splenectomy,so as to provide reference for clinical work after splenectomy.Methods:Finally,13 articles were included.Meta-analysis of related factors indicated that the results of preoperative portal pressure analysis were WMD=3.89;95% CI,0.48-7.29;P=0.03.This indicates that the portal vein pressure in thrombosis group is higher than that in non-thrombosis group.Postoperative portal pressure analysis showed WMD=-3.53;95% CI,-6.841-0.21;P = 0.04,which indicated that the portal pressure in thrombosis group was lower than that in non-thrombosis group.The results of portal vein velocity analysis after operation were WMD=-3.76;95% CI,-5.44-2.09;P<0.0001,indicating that portal vein velocity in portal thrombosis group was lower than that in non-thrombosis group.The results of intraoperative bleeding analysis showed that WMD = 112.34;95% CI,10.43-214.26;P = 0.03,indicating that the amount of intraoperative bleeding was more in thrombosis group than in non-thrombosis group.The results of operation time analysis were as follows: WMD= 11.06;95% CI,2.54-19.59;P = 0.01,indicating that the operation time was longer in thrombosis group than in non-thrombosis group.The etiological analysis of livercirrhosis was RR=1.24;95% CI,1.03-1.49;P=0.02,which indicated that patients with post-hepatitis cirrhosis were more likely to form portal vein thrombosis than other types of cirrhosis.Preoperative platelet count was WMD=-4.28;95% CI,-11.64-3.07;P = 0.25,indicating that preoperative platelet count was not associated with portal thrombosis.The results of platelet analysis on the 7th day after operation were WMD=41.83;95% CI,-64.05-147.71;P=0.44,indicating that the platelet count on the 7th day after operation was not related to portal thrombosis.RESULTS:Finally,13 articles were included.Meta-analysis of the related factors showed that the diameter of portal vein was wider(P<0.0001),the pressure of portal vein was higher(P=0.03),the pressure of portal vein was lower(P=0.04),the velocity of portal vein was lower(P<0.0001),the amount of bleeding during operation was more(P=0.03),and the operation time was longer(P=0.01)in thrombosis group than in non-thrombosis group.Postoperative cirrhosis was more common(P=0.02).The difference was statistically significant.There was no correlation with other factors.Conclusion:Through meta-analysis,we can conclude that: First,postoperative portal vein thrombosis is the result of many factors.Portal hemodynamic changes are the important influencing factors of portal vein thrombosis.Preoperative portal diameter,preoperative portal pressure,post-operative portal pressure,post-operative portal vein flow rate,bleeding volume,operation time and etiology are correlated with portal vein thrombosis,but more prospective studies are needed to confirm it.Second,the second splenic pedicle should be resected to avoid pancreas injury in order to reduce the occurrence of PVST.Third,Doppler ultrasonography can be used to monitor the hemodynamic changes of portal vein system after splenectomy combined with pericardial devascularization,and early warning of high-risk patients with PVST.Fourth,splenectomy combined with pericardial devascularization can provide early preventive anticoagulation therapy to reduce portal vein thrombosis under the condition of monitoring coagulation function. |
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