Multi-factor Analysis Of Portal Vein Thrombosis After Splenectomy Combined With Pericardia Devascularization And The Study Of Risk Assessment Model For Predicting Portal Vein Thrombosis

ObjectiveDiscusses implementation of splenectomy in combination with portal hypertension patients cardiac blood vessels around from postoperative portal vein thrombosis(PVST)system cause the risk factors,and to establish forecasting portal venous system thrombosis risk assessment model,for clinical to evaluate the risk of portal venous system thrombosis make guidance,in order to achieve early assessment,early prevention,early treatment,so as to reduce the risk of patients PVST formation and increase the effect of the prognosis of patients with purpose.MethodsClinical data of patients undergoing splenectomy combined with pericardial devascularization for portal hypertension of liver cirrhosis in henan provincial people's hospital from January 2012 to December 2018 were retrospectively collected.According to the postoperative portal venous thrombosis,the patients were divided into the thrombus group and the non-thrombus group,of which the follow-up time for postoperative thrombosis was 6 months.Screening effect the single factor analysis of portal venous system thrombosis associated risk factors,logistic analysis to rule out confounding factors affecting the formation of portal venous system thrombosis,and then introduced the receiver-operating characteristic curve(ROC)to further verify the above was statistically significant index for diagnosis of portal venous system thrombosis risk,the sensitivity and specificity with Hosmer--Lemeshow goodness-of-fit test evaluation model,about an index is used to determine the critical point of each index,portal venous system thrombosis risk evaluation model is set up,Different scores were assigned to risk factors affecting portal vein thrombosis,and then the scores of the thrombus group and the non-thrombus group were statistically analyzed to further verify the diagnostic value of the above factors in diagnosing the risk of portal vein thrombosis.ResultsA total of 726 patients were included,including 124 in the thrombus group and 602 in the non-thrombus group,with an incidence of thrombus(17.08%).Single factor analysis of two groups of patients with clinical data showed that age,operation method,body mass index(BMI),operation time,intraoperative blood loss,preoperative D-dimer level,whether merger history of bleeding,the Child-Pugh,liver function grade,total bilirubin(TBIL)and portal venous velocity difference,the diameter of portal vein,splenic vein diameter,degree of spleen,spleen longest diameter,whether the postoperative anticoagulation drugs,whether diabetes mellitus,preoperative blood urea nitrogen level,cereal third transaminase(ALT),preoperative platelet count and fibrinogen(FBG)index has a statistically significant difference between the(P < 0.05);There were no significant statistical differences in gender,albumin level,AST,direct bilirubin,partial prothrombin time(PT),activated partial prothrombin time(APTT),INR and serum creatinine levels(all P>0.05).Thrombosis patients age(64.25±6.657y)is significantly higher than the thrombus group(51.42±9.733y),blood clots in patients with laparoscopic surgery proportion(92.74%)was obviously higher than laparotomy(7.26%),thrombosis patients operation time(261.30 ±56.325 min)is greater than the thrombus group(187.26±45.774 min),portal venous flow velocity difference is higher than the thrombus group,preoperative D-dimer level thrombosis patients is higher than the thrombus group;Logistic multifactor regression analysis results show that the history of operation,BMI,diabetes mellitus,the degree of the spleen,spleen diameter,longest history of portal venous velocity difference,merge bleeding and preoperative D-dimer level is the effect of splenectomy in combination with portal hypertension patients cardiac blood vessels around from the independent risk factor for the formation of postoperative PVST,area under the ROC curve(AUC)in the above factors were greater than 0.5.The maximum jorden index was 0.634 when the longest diameter of spleen was 18.5.The maximum jorden index was 0.472 when the portal vein velocity difference was 6.5.The maximum Jordan index was 0.888 when the preoperative d-dimer level was 3.5.The area under the curve(AUC)of the regression model was 0.996,P < 0.001,and the hosmer-lemeshow goodness of fit test was used to evaluate the effect of the model,P=0.18 > 0.05,indicating that the goodness of fit of the regression equation was good.The PVST risk assessment model predicted that the area under the ROC curve of diagnostic value was 0.735,the sensitivity was 86.3%,and the specificity was 57.8%.ConclusionThe formation of PVST after splenectomy and pericardia vascular dissection in portal hypertension is caused by multiple factors,among which the surgical method,BMI,history of diabetes,degree of splenomegaly,longest diameter of the spleen,difference in portal vein velocity,history of combined bleeding and d-dimer level are independent risk factors affecting the formation of PVST.The PVST risk assessment model constructed based on the above risk factors can be better applied in clinical practice to guide clinicians in early screening and early prevention of high-risk patients so as to improve the prognosis of patients.