Research progress of portal vein thrombosis after splenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIE Fei ¹ , ZHONG Pingyong ¹ , HUA Hao ¹ , MOU Tinggang ¹ ,  YANG Qin ²

1. Department of Hepatobiliary and Pancreatic Surgery, The First People’s Hospital of Neijiang City, Neijiang, Sichuan 641000, P. R. China;
2. Department of Gastroenterology, The First People’s Hospital of Neijiang City , Neijiang, Sichuan 641000, P. R. China;

Corresponding author：

YANG Qin, Email: whitetower@163.com

Keywords：

portal vein thrombosis; splenectomy; liver fibrosis; anticoagulation; review

DOI：

10.7507/1007-9424.202003034

Video：

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Objective To summarize the pathogenesis, epidemiology, and risk factors of portal vein thrombosis after splenectomy, and combined with the latest advances in clinical prevention, diagnosis, and treatment of portal vein thrombosis after splenectomy, so as to provide some references for clinical prevention and treatment in the future.Method Literatures on portal vein thrombosis after splenectomy were collected and reviewed.Results The incidence of portal vein thrombosis after splenectomy was high and its occurrence was the result of multiple factors. It was mainly related to the change of splenic venous blood flow mechanics after splenectomy. In terms of diagnosis, enhanced CT scan was the first choice. Currently, there was no consensus on treatment options, which mainly focused on individualized treatment and emphasized that preventive anticoagulant use of low-molecular-weight heparin may reduce the risk of portal vein thrombosis.Conclusion The concept of tertiary prevention of portal vein thrombosis after splenectomy should be established, and individualized treatment should be adopted in combination with the patient’s condition.

Citation： XIE Fei, ZHONG Pingyong, HUA Hao, MOU Tinggang, YANG Qin. Research progress of portal vein thrombosis after splenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(11): 1457-1462. doi: 10.7507/1007-9424.202003034 Copy

1.	Wang M, Ding L, Xu M, et al. A novel method detecting the key clinic factors of portal vein system thrombosis of splenectomy & cardia devascularization patients for cirrhosis & portal hypertension. BMC Bioinformatics, 2019, 20(Suppl 22): 720.
2.	Huang D, Tao M, Cao L, et al. Risk factors and anticoagulation effects of portal vein system thrombosis after laparoscopic splenectomy in patients with or without cirrhosis. Surg Laparosc Endosc Percutan Tech, 2019, 29(6): 498-502.
3.	Targarona EM. Portal vein thrombosis after laparoscopic splenectomy: the size of the risk. Surg Innov, 2008, 15(4): 266-270.
4.	Brink JS, Brown AK, Palmer BA, et al. Portal vein thrombosis after laparoscopy-assisted splenectomy and cholecystectomy. J Pediatr Surg, 2003, 38(4): 644-647.
5.	Winslow ER, Brunt LM, Drebin JA, et al. Portal vein thrombosis after splenectomy. Am J Surg, 2002, 184(6): 631-635, 635-636.
6.	Qi R, Jin X, Shi H, et al. Effect of laparoscopic splenectomy on portal vein thrombosis and serum YKL-40 in patients with cirrhotic portal hypertension. Ann Hepatol, 2019, 18(6): 898-901.
7.	Ikeda M, Sekimoto M, Takiguchi S, et al. High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: a prospective study with contrast-enhanced CT scan. Ann Surg, 2005, 241(2): 208-216.
8.	Romano F, Caprotti R, Scaini A, et al. Elective laparoscopic splenectomy and thrombosis of the spleno-portal axis: a prospective study with ecocolordoppler ultrasound. Surg Laparosc Endosc Percutan Tech, 2006, 16(1): 4-7.
9.	郑波, 廖东旭, 杨训, 等. 门静脉高压性脾功能亢进患者腹腔镜脾切除术后并发门静脉系统血栓形成的危险因素研究. 中国普外基础与临床杂志, 2018, 25(4): 438-443.
10.	Crary SE, Buchanan GR. Vascular complications after splenectomy for hematologic disorders. Blood, 2009, 114(14): 2861-2868.
11.	Watters JM, Sambasivan CN, Zink K, et al. Splenectomy leads to a persistent hypercoagulable state after trauma. Am J Surg, 2010, 199(5): 646-651.
12.	Pommerening MJ, Rahbar E, Minei K, et al. Splenectomy is associated with hypercoagulable thrombelastography values and increased risk of thromboembolism. Surgery, 2015, 158(3): 618-626.
13.	Kawanaka H, Akahoshi T, Kinjo N, et al. Effect of laparoscopic splenectomy on portal haemodynamics in patients with liver cirrhosis and portal hypertension. Br J Surg, 2014, 101(12): 1585-1593.
14.	Danno K, Ikeda M, Sekimoto M, et al. Diameter of splenic vein is a risk factor for portal or splenic vein thrombosis after laparoscopic splenectomy. Surgery, 2009, 145(5): 457-464, 465-466.
15.	陈国富, 范国华. 脾切除术后门静脉系统血栓形成的临床分析. 中国普外基础与临床杂志, 2012, 19(6): 649-652.
16.	Faccia M, Ainora ME, Ponziani FR, et al. Portal vein thrombosis in cirrhosis: why a well-known complication is still matter of debate. World J Gastroenterol, 2019, 25(31): 4437-4451.
17.	Stine JG, Wang J, Shah PM, et al. Decreased portal vein velocity is predictive of the development of portal vein thrombosis: a matched case-control study. Liver Int, 2018, 38(1): 94-101.
18.	Violi F, Corazza GR, Caldwell SH, et al. Incidence and recurrence of portal vein thrombosis in cirrhotic patients. Thromb Haemost, 2019, 119(3): 496-499.
19.	Qi X, Han G, Ye C, et al. Splenectomy causes 10-fold increased risk of portal venous system thrombosis in liver cirrhosis patients. Med Sci Monit, 2016, 22: 2528-2550.
20.	Wosiewicz P, Żorniak M, Hartleb M, et al. Portal vein thrombosis in cirrhosis is not associated with intestinal barrier disruption or increased platelet aggregability. Clin Res Hepatol Gastroenterol, 2016, 40(6): 722-729.
21.	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.
22.	Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med, 2011, 365(2): 147-156.
23.	罗永香, 劳景茂, 郑达武, 等. 低分子肝素联合血栓通预防脾切除术后门静脉血栓的临床研究. 中国社区医师, 2018, 34(13): 55-56.
24.	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.
25.	Wu S, Wu Z, Zhang X, et al. The incidence and risk factors of portal vein system thrombosis after splenectomy and pericardial devascularization. Turk J Gastroenterol, 2015, 26(5): 423-428.
26.	姜德清, 黄继超, 安雪霞, 等. 脾切除断流术后门静脉血液流变学变化与门静脉血栓形成关系研究. 中华普通外科杂志, 2011, 26(12): 1045-1046.
27.	Patel AG, Parker JE, Wallwork B, et al. Massive splenomegaly is associated with significant morbidity after laparoscopic splenectomy. Ann Surg, 2003, 238(2): 235-240.
28.	Pietrabissa A, Moretto C, Antonelli G, et al. Thrombosis in the portal venous system after elective laparoscopic splenectomy. Surg Endosc, 2004, 18(7): 1140-1143.
29.	Sabbagh A, Keikhaei B, Joorabian M, et al. Retrospective study of the incidence of portal vein thrombosis after splenectomy in hematological disorders: risk factors and clinical presentation. Blood Cells Mol Dis, 2019, 74: 1-4.
30.	Kercher KW, Sing RF, Watson KW, et al. Transhepatic thrombolysis in acute portal vein thrombosis after laparoscopic splenectomy. Surg Laparosc Endosc Percutan Tech, 2002, 12(2): 131-136.
31.	Wang M, Zhang M, Li J, et al. Risk factors of portal vein thrombosis in patients with beta thalassemia major after splenectomy: laparoscopic versus open procedure. Hepatogastroenterology, 2014, 61(129): 48-54.
32.	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.
33.	Zhang Y, Wen TF, Yan LN, et al. Preoperative predictors of portal vein thrombosis after splenectomy with periesophagogastric devascularization. World J Gastroenterol, 2012, 18(15): 1834-1839.
34.	Kuroki T, Kitasato A, Tokunaga T, et al. Predictors of portal and splenic vein thrombosis after laparoscopic splenectomy: a retrospective analysis of a single-center experience. Surg Today, 2018, 48(8): 804-809.
35.	Cotter TG, Pillai AA. Consult for portal vein thrombosis. Clin Liver Dis (Hoboken), 2019, 14(2): 74-77.
36.	Borrazzo EC, Daly JM, Morrisey KP, et al. Hand-assisted laparoscopic splenectomy for giant spleens. Surg Endosc, 2003, 17(6): 918-920.
37.	虞哲科, 王晶晶, 邱振明, 等. 药物治疗门静脉系统血栓形成的疗效. 温州医科大学学报, 2018, 48(5): 383-384.
38.	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.
39.	Bai DS, Xia BL, Zhang C, et al. Warfarin versus aspirin prevents portal vein thrombosis after laparoscopic splenectomy and azygoportal disconnection: a randomized clinical trial. Int J Surg, 2019, 64: 16-23.
40.	梁刚, 王智翔, 何盟国, 等. 早期联合抗凝对脾切断流术后门静脉系统血栓形成的预防效果. 临床医学研究与实践, 2019, 4(4): 5-6, 9.
41.	Nakayasu H, Maeda M, Soda T, et al. The antiplatelet aggregation effects of aspirin suppositories. Cerebrovasc Dis, 2003, 16(1): 31-35.
42.	郑春雷, 赵永福, 唐哲, 等. 早期联合应用抗凝药物预防脾切断流术后门静脉血栓的形成. 世界华人消化杂志, 2015, 23(1): 129-133.
43.	魏俊凌. 急性门静脉血栓形成的临床诊断及治疗方法研究. 当代医学, 2014, 20(17): 94-95.
44.	赵东, 李红春, 陶红光, 等. 门静脉血栓形成的临床诊治分析. 中华肝脏外科手术学电子杂志, 2017, 6(1): 45-49.
45.	薛涣洲, 张宏伟, 张颖霞. 门静脉系统抗凝预防断流术后门静脉系血栓形成. 中华外科杂志, 2000, 38(11): 855.
46.	Brunaud L, Antunes L, Collinet-Adler S, et al. Acute mesenteric venous thrombosis: case for nonoperative management. J Vasc Surg, 2001, 34(4): 673-679.
47.	Qi X, Bai M, Guo X, et al. Pharmacologic prophylaxis of portal venous system thrombosis after splenectomy: a meta-analysis. Gastroenterol Res Pract, 2014, 2014: 292689.
48.	Kawanaka H, Akahoshi T, Itoh S, et al. Optimizing risk stratification in portal vein thrombosis after splenectomy and its primary prophylaxis with antithrombin Ⅲ concentrates and danaparoid sodium in liver cirrhosis with portal hypertension. J Am Coll Surg, 2014, 219(5): 865-874.
49.	张玮, 周大明, 李阳. 低分子肝素防治肝硬化及其脾切除术后门静脉栓塞的系统评价和 Meta 分析. 中华肝脏病杂志, 2016, 24(10): 732-737.
50.	杨世扬, 马春峰. 脾切除断流术后早期抗凝预防门静脉系统血栓形成 50 例分析. 中国医药指南, 2015, 13(21): 146, 147.
51.	张秋学, 张执全, 杨冬山, 等. 脾切除断流术后早期抗凝预防门静脉系统血栓形成. 中华普通外科杂志, 2012, 27(4): 302-305.
52.	张振, 王孟龙, 张海涛, 等. 肝硬化门静脉高压患者脾切除断流术后早期门静脉血栓形成的因素及预防性活血、抗凝、祛聚治疗的效果. 肝脏, 2019, 24(1): 24-27, 89.
53.	Samama CM, Gafsou B, Jeandel T, et al. French society of anaesthesia and intensive care. Guidelines on perioperative venous thromboembolism prophylaxis. Update 2011. Short text. Ann Fr Anesth Reanim, 2011, 30(12): 947-951.

1. Wang M, Ding L, Xu M, et al. A novel method detecting the key clinic factors of portal vein system thrombosis of splenectomy & cardia devascularization patients for cirrhosis & portal hypertension. BMC Bioinformatics, 2019, 20(Suppl 22): 720.
2. Huang D, Tao M, Cao L, et al. Risk factors and anticoagulation effects of portal vein system thrombosis after laparoscopic splenectomy in patients with or without cirrhosis. Surg Laparosc Endosc Percutan Tech, 2019, 29(6): 498-502.
3. Targarona EM. Portal vein thrombosis after laparoscopic splenectomy: the size of the risk. Surg Innov, 2008, 15(4): 266-270.
4. Brink JS, Brown AK, Palmer BA, et al. Portal vein thrombosis after laparoscopy-assisted splenectomy and cholecystectomy. J Pediatr Surg, 2003, 38(4): 644-647.
5. Winslow ER, Brunt LM, Drebin JA, et al. Portal vein thrombosis after splenectomy. Am J Surg, 2002, 184(6): 631-635, 635-636.
6. Qi R, Jin X, Shi H, et al. Effect of laparoscopic splenectomy on portal vein thrombosis and serum YKL-40 in patients with cirrhotic portal hypertension. Ann Hepatol, 2019, 18(6): 898-901.
7. Ikeda M, Sekimoto M, Takiguchi S, et al. High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: a prospective study with contrast-enhanced CT scan. Ann Surg, 2005, 241(2): 208-216.
8. Romano F, Caprotti R, Scaini A, et al. Elective laparoscopic splenectomy and thrombosis of the spleno-portal axis: a prospective study with ecocolordoppler ultrasound. Surg Laparosc Endosc Percutan Tech, 2006, 16(1): 4-7.
9. 郑波, 廖东旭, 杨训, 等. 门静脉高压性脾功能亢进患者腹腔镜脾切除术后并发门静脉系统血栓形成的危险因素研究. 中国普外基础与临床杂志, 2018, 25(4): 438-443.
10. Crary SE, Buchanan GR. Vascular complications after splenectomy for hematologic disorders. Blood, 2009, 114(14): 2861-2868.
11. Watters JM, Sambasivan CN, Zink K, et al. Splenectomy leads to a persistent hypercoagulable state after trauma. Am J Surg, 2010, 199(5): 646-651.
12. Pommerening MJ, Rahbar E, Minei K, et al. Splenectomy is associated with hypercoagulable thrombelastography values and increased risk of thromboembolism. Surgery, 2015, 158(3): 618-626.
13. Kawanaka H, Akahoshi T, Kinjo N, et al. Effect of laparoscopic splenectomy on portal haemodynamics in patients with liver cirrhosis and portal hypertension. Br J Surg, 2014, 101(12): 1585-1593.
14. Danno K, Ikeda M, Sekimoto M, et al. Diameter of splenic vein is a risk factor for portal or splenic vein thrombosis after laparoscopic splenectomy. Surgery, 2009, 145(5): 457-464, 465-466.
15. 陈国富, 范国华. 脾切除术后门静脉系统血栓形成的临床分析. 中国普外基础与临床杂志, 2012, 19(6): 649-652.
16. Faccia M, Ainora ME, Ponziani FR, et al. Portal vein thrombosis in cirrhosis: why a well-known complication is still matter of debate. World J Gastroenterol, 2019, 25(31): 4437-4451.
17. Stine JG, Wang J, Shah PM, et al. Decreased portal vein velocity is predictive of the development of portal vein thrombosis: a matched case-control study. Liver Int, 2018, 38(1): 94-101.
18. Violi F, Corazza GR, Caldwell SH, et al. Incidence and recurrence of portal vein thrombosis in cirrhotic patients. Thromb Haemost, 2019, 119(3): 496-499.
19. Qi X, Han G, Ye C, et al. Splenectomy causes 10-fold increased risk of portal venous system thrombosis in liver cirrhosis patients. Med Sci Monit, 2016, 22: 2528-2550.
20. Wosiewicz P, Żorniak M, Hartleb M, et al. Portal vein thrombosis in cirrhosis is not associated with intestinal barrier disruption or increased platelet aggregability. Clin Res Hepatol Gastroenterol, 2016, 40(6): 722-729.
21. 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.
22. Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med, 2011, 365(2): 147-156.
23. 罗永香, 劳景茂, 郑达武, 等. 低分子肝素联合血栓通预防脾切除术后门静脉血栓的临床研究. 中国社区医师, 2018, 34(13): 55-56.
24. 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.
25. Wu S, Wu Z, Zhang X, et al. The incidence and risk factors of portal vein system thrombosis after splenectomy and pericardial devascularization. Turk J Gastroenterol, 2015, 26(5): 423-428.
26. 姜德清, 黄继超, 安雪霞, 等. 脾切除断流术后门静脉血液流变学变化与门静脉血栓形成关系研究. 中华普通外科杂志, 2011, 26(12): 1045-1046.
27. Patel AG, Parker JE, Wallwork B, et al. Massive splenomegaly is associated with significant morbidity after laparoscopic splenectomy. Ann Surg, 2003, 238(2): 235-240.
28. Pietrabissa A, Moretto C, Antonelli G, et al. Thrombosis in the portal venous system after elective laparoscopic splenectomy. Surg Endosc, 2004, 18(7): 1140-1143.
29. Sabbagh A, Keikhaei B, Joorabian M, et al. Retrospective study of the incidence of portal vein thrombosis after splenectomy in hematological disorders: risk factors and clinical presentation. Blood Cells Mol Dis, 2019, 74: 1-4.
30. Kercher KW, Sing RF, Watson KW, et al. Transhepatic thrombolysis in acute portal vein thrombosis after laparoscopic splenectomy. Surg Laparosc Endosc Percutan Tech, 2002, 12(2): 131-136.
31. Wang M, Zhang M, Li J, et al. Risk factors of portal vein thrombosis in patients with beta thalassemia major after splenectomy: laparoscopic versus open procedure. Hepatogastroenterology, 2014, 61(129): 48-54.
32. 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.
33. Zhang Y, Wen TF, Yan LN, et al. Preoperative predictors of portal vein thrombosis after splenectomy with periesophagogastric devascularization. World J Gastroenterol, 2012, 18(15): 1834-1839.
34. Kuroki T, Kitasato A, Tokunaga T, et al. Predictors of portal and splenic vein thrombosis after laparoscopic splenectomy: a retrospective analysis of a single-center experience. Surg Today, 2018, 48(8): 804-809.
35. Cotter TG, Pillai AA. Consult for portal vein thrombosis. Clin Liver Dis (Hoboken), 2019, 14(2): 74-77.
36. Borrazzo EC, Daly JM, Morrisey KP, et al. Hand-assisted laparoscopic splenectomy for giant spleens. Surg Endosc, 2003, 17(6): 918-920.
37. 虞哲科, 王晶晶, 邱振明, 等. 药物治疗门静脉系统血栓形成的疗效. 温州医科大学学报, 2018, 48(5): 383-384.
38. 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.
39. Bai DS, Xia BL, Zhang C, et al. Warfarin versus aspirin prevents portal vein thrombosis after laparoscopic splenectomy and azygoportal disconnection: a randomized clinical trial. Int J Surg, 2019, 64: 16-23.
40. 梁刚, 王智翔, 何盟国, 等. 早期联合抗凝对脾切断流术后门静脉系统血栓形成的预防效果. 临床医学研究与实践, 2019, 4(4): 5-6, 9.
41. Nakayasu H, Maeda M, Soda T, et al. The antiplatelet aggregation effects of aspirin suppositories. Cerebrovasc Dis, 2003, 16(1): 31-35.
42. 郑春雷, 赵永福, 唐哲, 等. 早期联合应用抗凝药物预防脾切断流术后门静脉血栓的形成. 世界华人消化杂志, 2015, 23(1): 129-133.
43. 魏俊凌. 急性门静脉血栓形成的临床诊断及治疗方法研究. 当代医学, 2014, 20(17): 94-95.
44. 赵东, 李红春, 陶红光, 等. 门静脉血栓形成的临床诊治分析. 中华肝脏外科手术学电子杂志, 2017, 6(1): 45-49.
45. 薛涣洲, 张宏伟, 张颖霞. 门静脉系统抗凝预防断流术后门静脉系血栓形成. 中华外科杂志, 2000, 38(11): 855.
46. Brunaud L, Antunes L, Collinet-Adler S, et al. Acute mesenteric venous thrombosis: case for nonoperative management. J Vasc Surg, 2001, 34(4): 673-679.
47. Qi X, Bai M, Guo X, et al. Pharmacologic prophylaxis of portal venous system thrombosis after splenectomy: a meta-analysis. Gastroenterol Res Pract, 2014, 2014: 292689.
48. Kawanaka H, Akahoshi T, Itoh S, et al. Optimizing risk stratification in portal vein thrombosis after splenectomy and its primary prophylaxis with antithrombin Ⅲ concentrates and danaparoid sodium in liver cirrhosis with portal hypertension. J Am Coll Surg, 2014, 219(5): 865-874.
49. 张玮, 周大明, 李阳. 低分子肝素防治肝硬化及其脾切除术后门静脉栓塞的系统评价和 Meta 分析. 中华肝脏病杂志, 2016, 24(10): 732-737.
50. 杨世扬, 马春峰. 脾切除断流术后早期抗凝预防门静脉系统血栓形成 50 例分析. 中国医药指南, 2015, 13(21): 146, 147.
51. 张秋学, 张执全, 杨冬山, 等. 脾切除断流术后早期抗凝预防门静脉系统血栓形成. 中华普通外科杂志, 2012, 27(4): 302-305.
52. 张振, 王孟龙, 张海涛, 等. 肝硬化门静脉高压患者脾切除断流术后早期门静脉血栓形成的因素及预防性活血、抗凝、祛聚治疗的效果. 肝脏, 2019, 24(1): 24-27, 89.
53. Samama CM, Gafsou B, Jeandel T, et al. French society of anaesthesia and intensive care. Guidelines on perioperative venous thromboembolism prophylaxis. Update 2011. Short text. Ann Fr Anesth Reanim, 2011, 30(12): 947-951.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research progress of portal vein thrombosis after splenectomy

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