Predictive Factors for Portal Vein Thrombosis after Splenectomy and Gastroesophageal Devascularization_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 KUANGJie , YANGWei-ping , YANJi-qi , MADi ,  CHENHao , PENGCheng-hong , LIHong-wei

Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China;

Corresponding author：

CHENHao, Email: haochendr@126.com

Keywords：

Portal hypertension; Splenectomy; Gastroesophageal devascularization; Portal venous thrombosis; Prediction; Platelet; Fibrin degradation product

DOI：

10.7507/1007-9424.20150342

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Objective To investigate the predictive factors of portal vein thrombosis (PVT) before and after splenectomy and gastroesophageal devascularization for liver cirrhosis with portal hypertension. Methods Sixty-one cases of liver cirrhosis with portal hypertension who underwent splenectomy and gastroesophageal devascularization were enrolled retrospectively. The patients were divided into PVT group and non-PVT group based on the presence or absence of postoperative PVT on day 7. The clinical factors related with PVT were analyzed. Results There were 25 cases in the DVT group and 36 cases in the non-DVT group. The results of univariate analysis showed that the preoperative platelet (P=0.006), activated partial thromboplastin time (P=0.048), prothrombin time (P=0.028), and international normalized ratio (P=0.029), postoperative fibrin degradation product (P=0.002) and D-dimer (P=0.014) on day 1, portal venous diameter (P=0.050) had significant differences between the DVT group and non-DVT group. The results of logistic multivariate regression analysis showed that the preoperative platelet (OR=0.966, 95% CI 0.934-1.000, P=0.048) and postoperative fibrin degradation product on day 1(OR=1.055, 95% CI 1.011-1.103, P=0.017) were correlated with the PVT. The PVT might happen when preoperative platelet was less than 34.5×10⁹/L (sensitibity 80.6%, specificity 60.0%) or postoperative fibrin degradation product on day 1 was more than 64.75 mg/L (sensitibity 48.0%, specificity 91.7%). Conclusion Preoperative platelet and postoperative fibrin degradation product on day 1 might predict PVT after splenectomy and gastroesophageal devascularization for liver cirrhosis with portal hypertension.

Citation： KUANGJie, YANGWei-ping, YANJi-qi, MADi, CHENHao, PENGCheng-hong, LIHong-wei. Predictive Factors for Portal Vein Thrombosis after Splenectomy and Gastroesophageal Devascularization. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(11): 1305-1309. doi: 10.7507/1007-9424.20150342 Copy

1.	Francoz C, Belghiti J, Vilgrain V, et al. Splanchnic vein thrombosis in candidates for liver transplantation:usefulness of screening and anticoagulation. Gut, 2005, 54(5):691-697.
2.	Hanazaki K, Kajikawa S, Adachi W, et al. Portal vein thrombosis may be a fatal complication after synchronous splenectomy in patients with hepatocellular carcinoma and hypersplenism. J Am Coll Surg, 2000, 191(3):341-342.
3.	Manzanet G, Sanjuán F, Orbis P, et al. Liver transplantation in patients with portal vein thrombosis. Liver Transpl, 2001, 7(2):125-131.
4.	Krauth MT, Lechner K, Neugebauer EA, et al. The postoperative splenic/portal vein thrombosis after splenectomy and its prevention-an unresolved issue. Haematologica, 2008, 93(8):1227-1232.
5.	Lai W, Lu SC, Li GY, et al. Anticoagulation therapy prevents portalsplenic vein thrombosis after splenectomy with gastroesophageal devascularization. World J Gastroenterol, 2012, 18(26):3443-3450.
6.	匡洁, 杨卫平, 陈皓, 等.早期使用低分子肝素预防门静脉高压断流术后门静脉血栓形成.外科理论与实践, 2015, 20(2):131-134.
7.	Kawanaka H, Akahoshi T, Kinjo N, et al. Impact of antithrombinⅢconcentrates on portal vein thrombosis after splenectomy in patients with liver cirrhosis and hypersplenism. Ann Surg, 2010, 251(1):76-83.
8.	Ushitora Y, Tashiro H, Takahashi S, et al. Splenectomy in chronic hepatic disorders:portal vein thrombosis and improvement of liver function. Dig Surg, 2011, 28(1):9-14.
9.	Deng MH, Liu B, Fang HP, et al. Predictive value of D-dimer for portal vein thrombosis after portal hypertension surgery in hepatitis B virus-related cirrhosis. World J Gastroenterol, 2007, 13(48):6588-6592.
10.	匡洁, 杨卫平, 陈皓, 等.门静脉高压症术后门静脉血栓形成的危险因素分析.外科理论与实践, 2012, 17(6):634-638.
11.	Ikeda M, Sekimoto M, Takiguchi S, et al. Total splenic vein thrombosis after laparoscopic splenectomy:a possible candidate for treatment. Am J Surg, 2007, 193(1):21-25.
12.	Romano F, Caprotti R, Conti M, et al. Thrombosis of the splenoportal axis after splenectomy. Langenbecks Arch Surg, 2006, 391(5):483-488.
13.	Kinjo N, Kawanaka H, Akahoshi T, et al. Risk factors for portal venous thrombosis after splenectomy in patients with cirrhosis and portal hypertension. Br J Surg, 2010, 97(6):910-916.
14.	Kawanaka H, Akahoshi T, Itoh S, et al. Optimizing risk stratification in portal vein thrombosis after splenectomy and its primary prophylaxis with antithrombinⅢconcentrates and danaparoid sodium in liver cirrhosis with portal hypertension. J Am Coll Surg, 2014, 219(5):865-874.
15.	牛秀峰, 高林, 倪家连, 等.脾切除断流术后经脾静脉抗凝治疗预防早期门静脉血栓的安全性分析.肝胆胰外科杂志, 2012, 24(1):27-29.
16.	林栋栋, 刘晋宁, 卢实春, 等.门静脉高压症脾切除断流术后血流动力学变化及其临床意义.中国实用外科杂志, 2007, 27(8):644-645.
17.	Winslow ER, Brunt LM, Drebin JA, et al. Portal vein thrombosis after splenectomy. Am J Surg, 2002, 184(6):631-636.
18.	Fujita F, Lyass S, Otsuka K, et al. Portal vein thrombosis following splenectomy:identification of risk factors. Am Surg, 2003, 69(11):951-956.
19.	彭涛, 陆才德.门静脉高压症行脾切除术后门静脉血栓形成的预防及治疗新进展.现代实用医学, 2011, 23(3):355-357.
20.	Zocco MA, Di Stasio E, De Cristofaro R, et al. Thrombotic risk factors in patients with liver cirrhosis:correlation with MELD scoring system and portal vein thrombosis development. J Hepatol, 2009, 51(4):682-689.
21.	孙勇伟, 罗蒙, 陈炜, 等.门静脉高压症外科手术后门静脉系统血栓形成.外科理论与实践, 2006, 11(3):198-200.
22.	Berzigotti A, Seijo S, Arena U, et al. Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis. Gastroenterology, 2013, 144(1):102-111.e1.
23.	Kim BK, Han KH, Park JY, et al. A novel liver stiffness measurementbased prediction model for cirrhosis in hepatitis B patients. Liver Int, 2010, 30(7):1073-1081.
24.	李大伟.血浆D-二聚体对腹腔镜脾切除门奇静脉断流术后门静脉血栓形成的预测意义.中国普通外科杂志, 2014, 23(2):207-211.

1. Francoz C, Belghiti J, Vilgrain V, et al. Splanchnic vein thrombosis in candidates for liver transplantation:usefulness of screening and anticoagulation. Gut, 2005, 54(5):691-697.
2. Hanazaki K, Kajikawa S, Adachi W, et al. Portal vein thrombosis may be a fatal complication after synchronous splenectomy in patients with hepatocellular carcinoma and hypersplenism. J Am Coll Surg, 2000, 191(3):341-342.
3. Manzanet G, Sanjuán F, Orbis P, et al. Liver transplantation in patients with portal vein thrombosis. Liver Transpl, 2001, 7(2):125-131.
4. Krauth MT, Lechner K, Neugebauer EA, et al. The postoperative splenic/portal vein thrombosis after splenectomy and its prevention-an unresolved issue. Haematologica, 2008, 93(8):1227-1232.
5. Lai W, Lu SC, Li GY, et al. Anticoagulation therapy prevents portalsplenic vein thrombosis after splenectomy with gastroesophageal devascularization. World J Gastroenterol, 2012, 18(26):3443-3450.
6. 匡洁, 杨卫平, 陈皓, 等.早期使用低分子肝素预防门静脉高压断流术后门静脉血栓形成.外科理论与实践, 2015, 20(2):131-134.
7. Kawanaka H, Akahoshi T, Kinjo N, et al. Impact of antithrombinⅢconcentrates on portal vein thrombosis after splenectomy in patients with liver cirrhosis and hypersplenism. Ann Surg, 2010, 251(1):76-83.
8. Ushitora Y, Tashiro H, Takahashi S, et al. Splenectomy in chronic hepatic disorders:portal vein thrombosis and improvement of liver function. Dig Surg, 2011, 28(1):9-14.
9. Deng MH, Liu B, Fang HP, et al. Predictive value of D-dimer for portal vein thrombosis after portal hypertension surgery in hepatitis B virus-related cirrhosis. World J Gastroenterol, 2007, 13(48):6588-6592.
10. 匡洁, 杨卫平, 陈皓, 等.门静脉高压症术后门静脉血栓形成的危险因素分析.外科理论与实践, 2012, 17(6):634-638.
11. Ikeda M, Sekimoto M, Takiguchi S, et al. Total splenic vein thrombosis after laparoscopic splenectomy:a possible candidate for treatment. Am J Surg, 2007, 193(1):21-25.
12. Romano F, Caprotti R, Conti M, et al. Thrombosis of the splenoportal axis after splenectomy. Langenbecks Arch Surg, 2006, 391(5):483-488.
13. Kinjo N, Kawanaka H, Akahoshi T, et al. Risk factors for portal venous thrombosis after splenectomy in patients with cirrhosis and portal hypertension. Br J Surg, 2010, 97(6):910-916.
14. Kawanaka H, Akahoshi T, Itoh S, et al. Optimizing risk stratification in portal vein thrombosis after splenectomy and its primary prophylaxis with antithrombinⅢconcentrates and danaparoid sodium in liver cirrhosis with portal hypertension. J Am Coll Surg, 2014, 219(5):865-874.
15. 牛秀峰, 高林, 倪家连, 等.脾切除断流术后经脾静脉抗凝治疗预防早期门静脉血栓的安全性分析.肝胆胰外科杂志, 2012, 24(1):27-29.
16. 林栋栋, 刘晋宁, 卢实春, 等.门静脉高压症脾切除断流术后血流动力学变化及其临床意义.中国实用外科杂志, 2007, 27(8):644-645.
17. Winslow ER, Brunt LM, Drebin JA, et al. Portal vein thrombosis after splenectomy. Am J Surg, 2002, 184(6):631-636.
18. Fujita F, Lyass S, Otsuka K, et al. Portal vein thrombosis following splenectomy:identification of risk factors. Am Surg, 2003, 69(11):951-956.
19. 彭涛, 陆才德.门静脉高压症行脾切除术后门静脉血栓形成的预防及治疗新进展.现代实用医学, 2011, 23(3):355-357.
20. Zocco MA, Di Stasio E, De Cristofaro R, et al. Thrombotic risk factors in patients with liver cirrhosis:correlation with MELD scoring system and portal vein thrombosis development. J Hepatol, 2009, 51(4):682-689.
21. 孙勇伟, 罗蒙, 陈炜, 等.门静脉高压症外科手术后门静脉系统血栓形成.外科理论与实践, 2006, 11(3):198-200.
22. Berzigotti A, Seijo S, Arena U, et al. Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis. Gastroenterology, 2013, 144(1):102-111.e1.
23. Kim BK, Han KH, Park JY, et al. A novel liver stiffness measurementbased prediction model for cirrhosis in hepatitis B patients. Liver Int, 2010, 30(7):1073-1081.
24. 李大伟.血浆D-二聚体对腹腔镜脾切除门奇静脉断流术后门静脉血栓形成的预测意义.中国普通外科杂志, 2014, 23(2):207-211.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Predictive Factors for Portal Vein Thrombosis after Splenectomy and Gastroesophageal Devascularization

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