Analysis Of Risk Factors And Clinical Characteristics Of Portal Vein Thrombosis After Hepatectomy

Objective: Portal vein thrombosis is one of the fatal complications after hepatectomy.Its etiology is complex,and the incidence is occult,and there are no clinical manifestations or atypical symptoms and signs,so early diagnosis is difficult.At present,there are no relevant diagnosis and treatment guidelines or consensus of portal vein thrombosis after hepatectomy,and the mortality is high.For improving surgeons’ understanding of the disease and the prognosis of patients,we analyze the risk factors and summarize the diagnosis and treatment experience of portal vein thrombosis after hepatectomy.Methods: We reviewed the patients who underwent hepatectomy in Hepatobiliary and Pancreatic Center of Beijing Tsinghua Changgung Hospital from February 2015 to February 2021.Patients with portal vein thrombosis postoperative were included in observation group.The observation group was matched at 1:4 with patients without portal vein thrombosis after hepatectomy according to age(within two years),sex and operation date of hepatectomy(within two years).A case-control study was conducted between observation group and control group,and we analyzed the risk factors of portal vein thrombosis after hepatectomy retrospectively.we summarized the experience in diagnosis and treatment of portal vein thrombosis after hepatectomy,by describing the clinical data of patients with portal vein thrombosis after hepatectomy,such as demographic characteristics,primary disease,basic disease,hepatectomy,laboratory indexes before and after operation,time and method of diagnosis,treatment methods and prognosis of patients,Result:A total of 573 patients have understood hepatectomy in Hepatobiliary and Pancreatic Center of Beijing Tsinghua Changgung Hospital from February 2015 to February 2021.16 patients developed portal vein thrombosis after hepatectomy,and the morbidity of portal vein thrombosis after hepatectomy was 2.79%.Then 16 patients in observation group and 64 patients in control group were included in this study according to the matching criteria.Univariate analysis showed that the proportion of hilar cholangiocarcinoma(50.0% vs 20.3%;P=0.036),extrahepatic bile duct resection(75.0% vs 43.8%;P=0.025),portal vein reconstruction(31.3% vs 7.8%;P=0.035)and pancreaticoduodenectomy(18.8% vs 0%;P=0.007)in observation group were significantly higher than those in control group(P<0.05).Multivariate analysis showed that hepatopancreatoduodenectomy was an independent risk factor for portal vein thrombosis after operation [HR: 21.004;95% CI: 3.030--145.575;P=0.002].16 patients with portal vein thrombosis after hepatectomy mainly included hilar cholangiocarcinoma in 8 patients(50%)and hepatocellular carcinoma in 4patients(25%).The diagnosis time was from 1 to 24 days after hepatectomy,with an average of 9 days.4 patients(25.00%)had no clinical symptoms,9 patients(56.25%)had fever of unknown origin,4 patients(25.00%)had abdominal pain and nausea,3patients(18.75%)had abdominal distension,hematemesis,hematochezia and jaundice.5 patients(31.25%)eventually developed hepatic encephalopathy and liver failure.13patients(81.25%)showed a sudden increase after the gradual decrease of liver function indexes such as transaminase and bilirubin after hepatectomy.All patients were finally diagnosed by enhanced abdominal CT.After anticoagulation,interventional thrombolysis and thrombectomy,8 patients were improved and 8patients died.The mortality of portal vein thrombosis after hepatectomy was 50%.Conclusion: Hilar cholangiocarcinoma,hepatectomy with extrahepatic bile duct resection,hepatectomy with portal vein reconstruction and hepatectomy with pancreaticoduodenectomy are risk factors for portal vein thrombosis after hepatectomy.Hepatopancreaticoduodenectomy is an independent risk factor for portal vein thrombosis after operation.There are many risk factors for portal vein thrombosis after hepatectomy.Its clinical manifestations are not specific,and some patients do not have any clinical manifestations,which is mainly diagnosed by enhanced abdominal CT.After the formation of portal vein thrombosis,if not timely and correct intervention,the risk of serious complications such as liver failure is high,and the mortality is high.Early detection and early treatment are the keys to improve the prognosis of patients with portal vein thrombosis after hepatectomy.