Research of risk factors of postoperative portal vein system thrombus after laparoscopic splenectomy in treatment of portal hypertension and hypersplenism_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHENG Bo , LIAO Dongxu , YANG Xun , WANG Jian

The First Department of General Surgery, Sichuan Academy of Medical Sciences, Sichuan Provincial People’s Hospital, Chengdu 610072, P. R. China;

Corresponding author：

ZHENG Bo, Email: 2364912746@qq.com

Keywords：

portal vein system thrombosis; hypersplenism; portal hypertension; laparoscopic splenectomy; risk factor

DOI：

10.7507/1007-9424.201712041

Video：

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Objective To explore the risk factors of postoperative portal vein system thrombus (PVST) after laparoscopic splenectomy in treatment of portal hypertension and hypersplenism. Methods Clinical data of 76 patients with portal hypertension and hypersplenism who underwent laparoscopic splenectomy in the Sichuan Provincial People’s Hospital from January 2012 to January 2017 were analyzed. Results There were 31 patients suffered from PVST (PVST group), and other 45 patients enrolled in non-PVST group.There were significant differences on age, diameter of splenic vein, diameter of portal vein, blood flow velocity of portal vein, level of D-dimer, and platelet count between the PVST group and the non-PVST group (P<0.05), but there were no significant difference on gender, Child-Pugh classification, etiology of cirrhosis, operation time, intraoperative blood loss, postoperative complications, and prothrombin time between the two groups (P>0.05). Multivariate logistic regression analysis showed that, patients with age >50 years (RR=1.31, P=0.02), splenic vein diameter >12 mm ( RR=1.29, P<0.01), portal vein diameter >13 mm (RR=1.55, P=0.01), blood flow velocity of portal vein <18 cm/s ( RR=1.47, P<0.01), increases level of D-dimer (RR=2.89, P=0.03), and elevated platelet count (RR=1.82 P=0.02) had higher risk of postoperative PVST than those patients with age ≤50 years, splenic vein diameter ≤12 mm, portal vein diameter ≤13 mm, blood flow velocity of portal vein ≥18 cm/s, normal level of D-dimer and platelet count. Conclusion For patients with portal hypertension and hypersplenism who underwent laparoscopic splenectomy, we should pay more attention to the risk factor, such as D-dimer and so on, to avoid the occurrence of postoperative PVST.

Citation： ZHENG Bo, LIAO Dongxu, YANG Xun, WANG Jian. Research of risk factors of postoperative portal vein system thrombus after laparoscopic splenectomy in treatment of portal hypertension and hypersplenism. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(4): 438-443. doi: 10.7507/1007-9424.201712041 Copy

1.	殷芳, 郑盛, 杨兰艳, 等. 经皮胃冠状静脉栓塞术联合部分脾栓塞术治疗门静脉高压症. 中国医学创新, 2010, 7(35): 113-115.
2.	Yilmaz Ö, Kiziltan R, Almali N, et al. Portal venous thrombosis developing after torsion of a wandering spleen. Niger J Clin Pract, 2017, 20(3): 394-396.
3.	何崇武, 刘强. 门静脉高压脾切除术后门静脉血栓形成防治. 中国老年学杂志, 2014, 34(13): 3809-3811.
4.	易永祥, 韩建波, 赵亮, 等. 肝硬化基础的腹部脏器疾病外科手术治疗时脾功能亢进的处理. 肝胆外科杂志, 2012, 20(6): 411-413.
5.	宋耀东. 腹腔镜下脾切除与静脉断流治疗肝硬化门脉高压体会. 吉林医学, 2012, 33(28): 6146-6147.
6.	Ozdemir F, Ersan V, Baskiran A, et al. Surgical Treatment of Portal Vein Thrombosis With the Use of Cadaveric Venous Patch After Donor Hepatectomy: A Case Report. Transplant Proc, 2017, 49(3): 606-608.
7.	杨宏, 黄俏莉. 脾切除加断流术对门脉高压症血液及免疫功能的影响. 中国现代普通外科进展, 2012, 15(7): 588.
8.	周永. 原位脾切除术与托脾法切除术对肝硬化门脉高压性脾功能亢进患者的疗效比较. 临床合理用药杂志, 2016, 9(35): 127-128.
9.	刘桂杰, 张学利, 刘志恒, 等. 胰源性门静脉高压症的诊断及外科治疗. 医学理论与实践, 2013, 1(15): 1967-1969.
10.	唐才喜, 陈迅. 腹腔镜下脾切除联合贲门周围血管离断术治疗门静脉高压症 34 例体会. 肝胆胰外科杂志, 2015, 27(6): 512-514.
11.	曹技磊, 赖威, 卢实春. 脾切除术后门静脉血栓形成的风险因素. 北京医学, 2013, 35(12): 1033-1035.
12.	Seal JB, Bohorquez H, Battula N, et al. Balloon-Occlusion Technique for Managing Portal Vein Hemorrhage in Liver Transplantation. Ochsner J, 2017, 17(1): 76-79.
13.	柏斗胜, 蒋国庆, 陈平, 等. 腹腔镜脾切除治疗肝硬化门脉高压性脾亢患者术后门脉血栓的危险因素. 中华肝胆外科杂志, 2016, 22(6): 397-401.
14.	陆再英, 钟南山. 内科学. 北京: 人民卫生出版社, 2009: 446-463.
15.	黄浩夫, 陈孝平, 董家鸿, 等. 肝胆胰外科学. 北京: 人民卫生出版社, 2010: 1604-1620.
16.	郭静, 陈娟. 肝硬化门脉高压症合并脾功能亢进的病人施行 LS 术后 42 例护理经验. 世界最新医学信息文摘 (连续型电子期刊), 2014, 2(36): 402-403.
17.	吕达, 陈英慧. 脾部分切除术治疗门静脉高压的临床研究. 中国实用医药, 2011, 6(18): 68-69.
18.	吴晔, 卞策, 汪忠镐, 等. 手术治愈门静脉系广泛血栓形成致肠坏死一例. 中华临床医师杂志 (电子版), 2012, 6(21): 7018-7019.
19.	张宝珠. 区域性门脉高压症 5 例诊治报告. 中国社区医师 (医学专业), 2010, 12(6): 115.
20.	许朱定, 张海斌, 沈翔, 等. 非手术治疗门静脉血栓形成 56 例治疗体会. 西南国防医药, 2013, 23(9): 994-996.
21.	王淑静, 付雍, 李娜, 等. 10 例区域性肝切除联合脾切除及门奇静脉断流术后急性门静脉栓塞患者的护理. 护理学报, 2014, 3(19): 64-66.
22.	迟长昆, 武扬, 张坤. 脾切除联合断流术后门静脉系统血栓形成的临床分析. 医药前沿, 2013, 17(28): 228-229.
23.	吴林峰, 卢榜裕, 蔡小勇, 等. 腹腔镜与传统开腹手术治疗肝硬化门静脉高压症疗效的对比研究. 肝胆胰外科杂志, 2014, 26(6): 513-516.
24.	宫卫东, 薛克, 褚延魁, 等. 胃冠状静脉栓塞联合部分脾栓塞治疗食管静脉曲张出血和脾功能亢进症:与外科手术比较. 介入放射学杂志, 2010, 19(2): 105-109.
25.	Abdelmaksoud AH, Mandooh S, Nabeel MM, et al. Portal Vein Thrombosis in Unresectable Hcc Cases: a Single Center Study of Prognostic Factors and Management in 140 Patients Asian Pac J Cancer Prev, 2017, 18(1): 183-188.
26.	傅振会, 任波, 赵群都. 低分子肝素钙预防 ICU 患者静脉血栓栓塞症的临床观察. 中国药房, 2016, 27(20): 2838-2840, 2841.
27.	徐锋, 王超, 唐斌, 等. 低分子肝素钙联合右旋糖酐预防门静脉高压症脾切除术后早期门静脉血栓形成. 中华普通外科杂志, 2016, 31(11): 936-939.

1. 殷芳, 郑盛, 杨兰艳, 等. 经皮胃冠状静脉栓塞术联合部分脾栓塞术治疗门静脉高压症. 中国医学创新, 2010, 7(35): 113-115.
2. Yilmaz Ö, Kiziltan R, Almali N, et al. Portal venous thrombosis developing after torsion of a wandering spleen. Niger J Clin Pract, 2017, 20(3): 394-396.
3. 何崇武, 刘强. 门静脉高压脾切除术后门静脉血栓形成防治. 中国老年学杂志, 2014, 34(13): 3809-3811.
4. 易永祥, 韩建波, 赵亮, 等. 肝硬化基础的腹部脏器疾病外科手术治疗时脾功能亢进的处理. 肝胆外科杂志, 2012, 20(6): 411-413.
5. 宋耀东. 腹腔镜下脾切除与静脉断流治疗肝硬化门脉高压体会. 吉林医学, 2012, 33(28): 6146-6147.
6. Ozdemir F, Ersan V, Baskiran A, et al. Surgical Treatment of Portal Vein Thrombosis With the Use of Cadaveric Venous Patch After Donor Hepatectomy: A Case Report. Transplant Proc, 2017, 49(3): 606-608.
7. 杨宏, 黄俏莉. 脾切除加断流术对门脉高压症血液及免疫功能的影响. 中国现代普通外科进展, 2012, 15(7): 588.
8. 周永. 原位脾切除术与托脾法切除术对肝硬化门脉高压性脾功能亢进患者的疗效比较. 临床合理用药杂志, 2016, 9(35): 127-128.
9. 刘桂杰, 张学利, 刘志恒, 等. 胰源性门静脉高压症的诊断及外科治疗. 医学理论与实践, 2013, 1(15): 1967-1969.
10. 唐才喜, 陈迅. 腹腔镜下脾切除联合贲门周围血管离断术治疗门静脉高压症 34 例体会. 肝胆胰外科杂志, 2015, 27(6): 512-514.
11. 曹技磊, 赖威, 卢实春. 脾切除术后门静脉血栓形成的风险因素. 北京医学, 2013, 35(12): 1033-1035.
12. Seal JB, Bohorquez H, Battula N, et al. Balloon-Occlusion Technique for Managing Portal Vein Hemorrhage in Liver Transplantation. Ochsner J, 2017, 17(1): 76-79.
13. 柏斗胜, 蒋国庆, 陈平, 等. 腹腔镜脾切除治疗肝硬化门脉高压性脾亢患者术后门脉血栓的危险因素. 中华肝胆外科杂志, 2016, 22(6): 397-401.
14. 陆再英, 钟南山. 内科学. 北京: 人民卫生出版社, 2009: 446-463.
15. 黄浩夫, 陈孝平, 董家鸿, 等. 肝胆胰外科学. 北京: 人民卫生出版社, 2010: 1604-1620.
16. 郭静, 陈娟. 肝硬化门脉高压症合并脾功能亢进的病人施行 LS 术后 42 例护理经验. 世界最新医学信息文摘 (连续型电子期刊), 2014, 2(36): 402-403.
17. 吕达, 陈英慧. 脾部分切除术治疗门静脉高压的临床研究. 中国实用医药, 2011, 6(18): 68-69.
18. 吴晔, 卞策, 汪忠镐, 等. 手术治愈门静脉系广泛血栓形成致肠坏死一例. 中华临床医师杂志 (电子版), 2012, 6(21): 7018-7019.
19. 张宝珠. 区域性门脉高压症 5 例诊治报告. 中国社区医师 (医学专业), 2010, 12(6): 115.
20. 许朱定, 张海斌, 沈翔, 等. 非手术治疗门静脉血栓形成 56 例治疗体会. 西南国防医药, 2013, 23(9): 994-996.
21. 王淑静, 付雍, 李娜, 等. 10 例区域性肝切除联合脾切除及门奇静脉断流术后急性门静脉栓塞患者的护理. 护理学报, 2014, 3(19): 64-66.
22. 迟长昆, 武扬, 张坤. 脾切除联合断流术后门静脉系统血栓形成的临床分析. 医药前沿, 2013, 17(28): 228-229.
23. 吴林峰, 卢榜裕, 蔡小勇, 等. 腹腔镜与传统开腹手术治疗肝硬化门静脉高压症疗效的对比研究. 肝胆胰外科杂志, 2014, 26(6): 513-516.
24. 宫卫东, 薛克, 褚延魁, 等. 胃冠状静脉栓塞联合部分脾栓塞治疗食管静脉曲张出血和脾功能亢进症:与外科手术比较. 介入放射学杂志, 2010, 19(2): 105-109.
25. Abdelmaksoud AH, Mandooh S, Nabeel MM, et al. Portal Vein Thrombosis in Unresectable Hcc Cases: a Single Center Study of Prognostic Factors and Management in 140 Patients Asian Pac J Cancer Prev, 2017, 18(1): 183-188.
26. 傅振会, 任波, 赵群都. 低分子肝素钙预防 ICU 患者静脉血栓栓塞症的临床观察. 中国药房, 2016, 27(20): 2838-2840, 2841.
27. 徐锋, 王超, 唐斌, 等. 低分子肝素钙联合右旋糖酐预防门静脉高压症脾切除术后早期门静脉血栓形成. 中华普通外科杂志, 2016, 31(11): 936-939.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research of risk factors of postoperative portal vein system thrombus after laparoscopic splenectomy in treatment of portal hypertension and hypersplenism

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