Risk Factors Of Portal Vein Thrombosis After Splenectomy With Liver Cirrhosis Ralated Portal Hypertension

Objective: To analyze the risk factors of portal venous thrombosis after splenectomy in patients with cirrhosis of the liver and portal hypertension(PH),and explore the influence factors of shengjing classification.Methods: The clinical data of 278 patients with cirrhosis and portal hypertension who underwent splenectomy in the department of general surgery of Shengjing hospital affiliated to China medical university from November 2011 to December 2018 were retrospectively analyzed.Results: Postoperative imaging showed that 108 of the 278 patients developed postoperative portal venous thrombosis,and the incidence of thrombosis was 38.8%.There was no significant difference between the two groups in age,gender,history of hypertension,history of diabetes,etiology of cirrhosis,Child grade of liver function,ascites or not,preoperative portal vein diameter,preoperative albumin level,preoperative ALT,preoperative total bilirubin,preoperative platelet,preoperative PT,preoperative APTT,preoperative FIB,preoperative TT,preoperative d-dimeric,splenic index,Intraoperative blood loss,intraoperative cryoprecipitation,intraoperative platelet transfusion,postoperative portal vein diameter,postoperative drainage volume,PT levels at 1st,7th and 14 th day after surgery,INR at 1st,7th and 14 th day after surgery,APTT at7 th and 14 th day after surgery,FIB at 1st and 14 th day after surgery,TT at 1st and 14 th day after surgery and DD at 14 th day after surgery(P > 0.05);The differences of operation time,postoperative splenic vein diameter,intraoperative RBC transfusion,intraoperative plasma transfusion and TT at the 7th day after the operation between the thrombus group and the non-thrombus group were statistically significant(P < 0.05).Operation time(OR=1.047,CI 1.000 ? 1.008,P=0.047),postoperative splenic vein diameter(OR=5.183,CI 2.040 ? 13.173,P=0.001),intraoperative plasma volume(OR=1.002,CI 1.001 ? 1.003,P=0.001)are independent risk factors.Intraoperative RBC transfusion volume(OR=0.722,CI = 0.617 ? 0.846,P < 0.001)and TT(OR=0.805,CI =0.660 ? 0.981,P=0.032)on the 7th day after surgery were independent protective factors.When the operating time exceeded 244.5min(area under ROC curve 0.651,95% CI0.585 ? 0.716),the diameter of splenic vein after operation was greater than 1.025cm(area under ROC curve 0.665,95% CI 0.598 ? 0.731),or the intraoperative plasma transfusion was greater than 550ml(area under ROC curve 0).When 756,95% CI is0.546 ? 0.684),postoperative portal vein thrombosis is likely to occur;When the intraoperative RBC transfusion was greater than 1.925u(ROC area 0.583,95% CI 0.514? 0.651)or the TT was greater than 15.65s(ROC area 0.634,95% CI 0.568 ? 0.699)on the 7th day after the operation,portal vein thrombosis was not easy to occur after the operation.Among 108 patients with postoperative PVST formation,type Ia 9,type Ib 32,type IIa39,type IIb 20,type IIIa 5,type IIIb 3,and type IV 0.Survival analysis showed that the difference of survival time distribution among shengjing typing groups was statistically significant(P < 0.05).The higher the classification level,the shorter the survival time and the higher the risk of death.The results of single factor analysis showed that there were statistically significant differences in PVST shengjing typing group between the preoperative group with or without hepatitis,preoperative d-dimer level and postoperative day 14 fibrinogen(FIB)level(P < 0.05).Multivariate Logistic regression analysis showed the OR value of higher PVST shengjing typing in patients with hepatitis was 4.634 times higher than that in patients without hepatitis,(95%CI:1.593-13.478),?2=7.922,P=0.005 <0.05.Preoperative d-dimer volume increased by 1 ug/L,the OR value of higher grade PVST shengjing typing was 1.001times(95%CI: 1.000-1.002)than that of lower grade PVST shengjing typing,2=8.369,P=0.004 < 0.05.Conclusion: For PH patients with cirrhosis,the operation time should be shortened as far as possible.During the perioperative period,red blood cells can be transfused appropriately and plasma transfusion can be reduced to prevent PVST,PVST formation can also be predicted according to postoperative splenic vein diameter and TT level on the 7th day after surgery.Moreover,the prediction efficiency of PVST after surgery could be improved by taking the above factors into consideration.The survival time of patients with portal vein system thrombosis after splenectomy was significantly different among shengjing typing groups.and the higher the classification level,the shorter the survival time and the higher the risk of death.Patients with portal hypertension in cirrhosis and PVST formation after splenectomy,if the preoperatived-dimer level is high or accompanied by hepatitis virus,the formation of PVST will involve a wide range,the disease is more serious,and the prognosis is also poor,so corresponding preventive measures should be taken to avoid the aggravation of PVST.