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, 鄭盛, 楊蘭艷, 等. 經皮胃冠狀靜脈栓塞術聯合部分脾栓塞術治療門靜脈高壓癥. 中國醫學創新, 2010, 7(35): 113-115.
2.	Yilmaz ?, 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, 劉強. 門靜脈高壓脾切除術后門靜脈血栓形成防治. 中國老年學雜志, 2014, 34(13): 3809-3811.
4.	易永祥, 韓建波, 趙亮, 等. 肝硬化基礎的腹部臟器疾病外科手術治療時脾功能亢進的處理. 肝膽外科雜志, 2012, 20(6): 411-413.
5.	宋耀東. 腹腔鏡下脾切除與靜脈斷流治療肝硬化門脈高壓體會. 吉林醫學, 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.	楊宏, 黃俏莉. 脾切除加斷流術對門脈高壓癥血液及免疫功能的影響. 中國現代普通外科進展, 2012, 15(7): 588.
8.	周永. 原位脾切除術與托脾法切除術對肝硬化門脈高壓性脾功能亢進患者的療效比較. 臨床合理用藥雜志, 2016, 9(35): 127-128.
9.	劉桂杰, 張學利, 劉志恒, 等. 胰源性門靜脈高壓癥的診斷及外科治療. 醫學理論與實踐, 2013, 1(15): 1967-1969.
10.	唐才喜, 陳迅. 腹腔鏡下脾切除聯合賁門周圍血管離斷術治療門靜脈高壓癥 34 例體會. 肝膽胰外科雜志, 2015, 27(6): 512-514.
11.	曹技磊, 賴威, 盧實春. 脾切除術后門靜脈血栓形成的風險因素. 北京醫學, 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.	柏斗勝, 蔣國慶, 陳平, 等. 腹腔鏡脾切除治療肝硬化門脈高壓性脾亢患者術后門脈血栓的危險因素. 中華肝膽外科雜志, 2016, 22(6): 397-401.
14.	陸再英, 鐘南山. 內科學. 北京: 人民衛生出版社, 2009: 446-463.
15.	黃浩夫, 陳孝平, 董家鴻, 等. 肝膽胰外科學. 北京: 人民衛生出版社, 2010: 1604-1620.
16.	郭靜, 陳娟. 肝硬化門脈高壓癥合并脾功能亢進的病人施行 LS 術后 42 例護理經驗. 世界最新醫學信息文摘 (連續型電子期刊), 2014, 2(36): 402-403.
17.	呂達, 陳英慧. 脾部分切除術治療門靜脈高壓的臨床研究. 中國實用醫藥, 2011, 6(18): 68-69.
18.	吳曄, 卞策, 汪忠鎬, 等. 手術治愈門靜脈系廣泛血栓形成致腸壞死一例. 中華臨床醫師雜志 (電子版), 2012, 6(21): 7018-7019.
19.	張寶珠. 區域性門脈高壓癥 5 例診治報告. 中國社區醫師 (醫學專業), 2010, 12(6): 115.
20.	許朱定, 張海斌, 沈翔, 等. 非手術治療門靜脈血栓形成 56 例治療體會. 西南國防醫藥, 2013, 23(9): 994-996.
21.	王淑靜, 付雍, 李娜, 等. 10 例區域性肝切除聯合脾切除及門奇靜脈斷流術后急性門靜脈栓塞患者的護理. 護理學報, 2014, 3(19): 64-66.
22.	遲長昆, 武揚, 張坤. 脾切除聯合斷流術后門靜脈系統血栓形成的臨床分析. 醫藥前沿, 2013, 17(28): 228-229.
23.	吳林峰, 盧榜裕, 蔡小勇, 等. 腹腔鏡與傳統開腹手術治療肝硬化門靜脈高壓癥療效的對比研究. 肝膽胰外科雜志, 2014, 26(6): 513-516.
24.	宮衛東, 薛克, 褚延魁, 等. 胃冠狀靜脈栓塞聯合部分脾栓塞治療食管靜脈曲張出血和脾功能亢進癥:與外科手術比較. 介入放射學雜志, 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.	傅振會, 任波, 趙群都. 低分子肝素鈣預防 ICU 患者靜脈血栓栓塞癥的臨床觀察. 中國藥房, 2016, 27(20): 2838-2840, 2841.
27.	徐鋒, 王超, 唐斌, 等. 低分子肝素鈣聯合右旋糖酐預防門靜脈高壓癥脾切除術后早期門靜脈血栓形成. 中華普通外科雜志, 2016, 31(11): 936-939.

1. 殷芳, 鄭盛, 楊蘭艷, 等. 經皮胃冠狀靜脈栓塞術聯合部分脾栓塞術治療門靜脈高壓癥. 中國醫學創新, 2010, 7(35): 113-115.
2. Yilmaz ?, 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, 劉強. 門靜脈高壓脾切除術后門靜脈血栓形成防治. 中國老年學雜志, 2014, 34(13): 3809-3811.
4. 易永祥, 韓建波, 趙亮, 等. 肝硬化基礎的腹部臟器疾病外科手術治療時脾功能亢進的處理. 肝膽外科雜志, 2012, 20(6): 411-413.
5. 宋耀東. 腹腔鏡下脾切除與靜脈斷流治療肝硬化門脈高壓體會. 吉林醫學, 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. 楊宏, 黃俏莉. 脾切除加斷流術對門脈高壓癥血液及免疫功能的影響. 中國現代普通外科進展, 2012, 15(7): 588.
8. 周永. 原位脾切除術與托脾法切除術對肝硬化門脈高壓性脾功能亢進患者的療效比較. 臨床合理用藥雜志, 2016, 9(35): 127-128.
9. 劉桂杰, 張學利, 劉志恒, 等. 胰源性門靜脈高壓癥的診斷及外科治療. 醫學理論與實踐, 2013, 1(15): 1967-1969.
10. 唐才喜, 陳迅. 腹腔鏡下脾切除聯合賁門周圍血管離斷術治療門靜脈高壓癥 34 例體會. 肝膽胰外科雜志, 2015, 27(6): 512-514.
11. 曹技磊, 賴威, 盧實春. 脾切除術后門靜脈血栓形成的風險因素. 北京醫學, 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. 柏斗勝, 蔣國慶, 陳平, 等. 腹腔鏡脾切除治療肝硬化門脈高壓性脾亢患者術后門脈血栓的危險因素. 中華肝膽外科雜志, 2016, 22(6): 397-401.
14. 陸再英, 鐘南山. 內科學. 北京: 人民衛生出版社, 2009: 446-463.
15. 黃浩夫, 陳孝平, 董家鴻, 等. 肝膽胰外科學. 北京: 人民衛生出版社, 2010: 1604-1620.
16. 郭靜, 陳娟. 肝硬化門脈高壓癥合并脾功能亢進的病人施行 LS 術后 42 例護理經驗. 世界最新醫學信息文摘 (連續型電子期刊), 2014, 2(36): 402-403.
17. 呂達, 陳英慧. 脾部分切除術治療門靜脈高壓的臨床研究. 中國實用醫藥, 2011, 6(18): 68-69.
18. 吳曄, 卞策, 汪忠鎬, 等. 手術治愈門靜脈系廣泛血栓形成致腸壞死一例. 中華臨床醫師雜志 (電子版), 2012, 6(21): 7018-7019.
19. 張寶珠. 區域性門脈高壓癥 5 例診治報告. 中國社區醫師 (醫學專業), 2010, 12(6): 115.
20. 許朱定, 張海斌, 沈翔, 等. 非手術治療門靜脈血栓形成 56 例治療體會. 西南國防醫藥, 2013, 23(9): 994-996.
21. 王淑靜, 付雍, 李娜, 等. 10 例區域性肝切除聯合脾切除及門奇靜脈斷流術后急性門靜脈栓塞患者的護理. 護理學報, 2014, 3(19): 64-66.
22. 遲長昆, 武揚, 張坤. 脾切除聯合斷流術后門靜脈系統血栓形成的臨床分析. 醫藥前沿, 2013, 17(28): 228-229.
23. 吳林峰, 盧榜裕, 蔡小勇, 等. 腹腔鏡與傳統開腹手術治療肝硬化門靜脈高壓癥療效的對比研究. 肝膽胰外科雜志, 2014, 26(6): 513-516.
24. 宮衛東, 薛克, 褚延魁, 等. 胃冠狀靜脈栓塞聯合部分脾栓塞治療食管靜脈曲張出血和脾功能亢進癥:與外科手術比較. 介入放射學雜志, 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. 傅振會, 任波, 趙群都. 低分子肝素鈣預防 ICU 患者靜脈血栓栓塞癥的臨床觀察. 中國藥房, 2016, 27(20): 2838-2840, 2841.
27. 徐鋒, 王超, 唐斌, 等. 低分子肝素鈣聯合右旋糖酐預防門靜脈高壓癥脾切除術后早期門靜脈血栓形成. 中華普通外科雜志, 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

Abstract Full text Figures/Tables Video References Cited by

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