The Risk Factors Of Portal Vein Thrombosis After Splenectomy Combined With Pericardial Devascularization

Objective:To analysis the risk factors and related indicators for predictive function for Portal Vein System Thrombosis(PVST)of patients with cirrhosis,portal hypertension,hypersplenism,esophageal and gastric varices,whose previous conservative treatment of upper gastrointestinal bleeding is invalid after laparoscopic splenectomy combined with pericardial devascularization(SPD).In order to provide a basis for prevention of PVST after SPD in clinical work,reduce the incidence of thrombotic events,improve patients' prognosis and quality of life.Research methods:A retrospective study was conducted on clinical data of 88 patients who underwent laparoscopic splenectomy combined with pericardial vascular dissection in the Department of Hepatobiliary Surgery,Affiliated Hospital of from June 2015 to November 2018.64 Patients were included according to the clinical data integrity and loss of follow-up.All of the patients is with cirrhosis,portal hypertension,hypersplenism,esophageal and gastric varices,and their previous conservative treatment of upper gastrointestinal bleeding is invalid.A special phenomenon of the fundus varices was found by gastroscopy.The patients with preoperative PVST is excluded by color Doppler ultrasound.Before the operation,the grade A or grade B was collected according to the Child-Pugh classification of liver function,and then the liver protection and other related treatments were adjusted to grade A before surgery.Platelet count(PLT),International Normalized Ratio(INR),Prothrombin Time(PT),Activated Partial Prothrombin Time(Activated Partial Prothrombin Time)were collected from the final enrolled group.,Then we collected PLT,APTT,INR,PT and other blood indicators postoperative 1,3,5,7days.Color Doppler ultrasound is used to measure preoperative and postoperative portal vein diameter.we collected clinical data of 3 months after surgery.Patients were divided into PVST group and non-PVST group according to whether postoperative PVST occurred.Comparative data include gender,age,BMI,previous diabetes,previous hypertension,portal vein diameter(measured by color Doppler ultrasound),blood cell analysis,coagulation,operative time,intraoperative blood loss,postoperative hemostatic drugs The application of factors such as PVST has statistical significance,looking for possible factors related to PVST after SPD,and logistic regression analysis of relevant risk factors,to identify,analyze and summarize the possibility of PVST after surgery Risk factors.Results:1.In the final 64 patients who underwent splenectomy(SPD),22 patients developed PVST after surgery,and 42 patients did not developed PVST,the incidence rate was 34.38%.2.Gender,age,BMI,alcohol history,previous diabetes,smoking history,previous hypertension,preoperative APTT,preoperative PT,preoperative INR,postoperative APTT,PT,INR 1,3,5,7days after surgery,PLT 1,3,5,7days after surgery,postoperative superior mesenteric vein,operation time,intraoperative blood loss,hemostatic drugs showed no significant difference between the PVST group and the non-pvst group(P>0.05).3.Preoperative platelet count(PLT),preoperative portal vein diameter,preoperative splenic vein diameter,preoperative superior mesenteric vein diameter,postoperative portal vein diameter,postoperative splenic vein diameter showed Statistically significant difference between the PVST group and the non-pvst group(P<0.05).4.According to the above analysis results,the logistic regression multivariate analysis was used to analyze the risk factors related to PVST formation after SPD.The results showed that the portal vein diameter measured before operation was different between PVST group and non-PVST group,which may be postoperative.Independent risk factors for thrombotic events(OR = 2.377,P < 0.05).Conclusion:1.Preoperative platelet count(PLT),preoperative portal vein diameter,preoperative splenic vein diameter,preoperative superior mesenteric vein diameter,postoperative portal vein diameter,postoperative splenic vein diameter may be risk factors of PVST formation after splenectomy and devascularization(SPD).2.Logistic regression results showed that preoperative portal vein diameter may be an independent risk factor for PVST after SPD.