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：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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.	鄭波, 廖東旭, 楊訓, 等. 門靜脈高壓性脾功能亢進患者腹腔鏡脾切除術后并發門靜脈系統血栓形成的危險因素研究. 中國普外基礎與臨床雜志, 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.	陳國富, 范國華. 脾切除術后門靜脈系統血栓形成的臨床分析. 中國普外基礎與臨床雜志, 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, ?orniak 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.	羅永香, 勞景茂, 鄭達武, 等. 低分子肝素聯合血栓通預防脾切除術后門靜脈血栓的臨床研究. 中國社區醫師, 2018, 34(13): 55-56.
24.	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.
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, 黃繼超, 安雪霞, 等. 脾切除斷流術后門靜脈血液流變學變化與門靜脈血栓形成關系研究. 中華普通外科雜志, 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. 藥物治療門靜脈系統血栓形成的療效. 溫州醫科大學學報, 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.	梁剛, 王智翔, 何盟國, 等. 早期聯合抗凝對脾切斷流術后門靜脈系統血栓形成的預防效果. 臨床醫學研究與實踐, 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.	鄭春雷, 趙永福, 唐哲, 等. 早期聯合應用抗凝藥物預防脾切斷流術后門靜脈血栓的形成. 世界華人消化雜志, 2015, 23(1): 129-133.
43.	魏俊凌. 急性門靜脈血栓形成的臨床診斷及治療方法研究. 當代醫學, 2014, 20(17): 94-95.
44.	趙東, 李紅春, 陶紅光, 等. 門靜脈血栓形成的臨床診治分析. 中華肝臟外科手術學電子雜志, 2017, 6(1): 45-49.
45.	薛渙洲, 張宏偉, 張穎霞. 門靜脈系統抗凝預防斷流術后門靜脈系血栓形成. 中華外科雜志, 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.	張瑋, 周大明, 李陽. 低分子肝素防治肝硬化及其脾切除術后門靜脈栓塞的系統評價和 Meta 分析. 中華肝臟病雜志, 2016, 24(10): 732-737.
50.	楊世揚, 馬春峰. 脾切除斷流術后早期抗凝預防門靜脈系統血栓形成 50 例分析. 中國醫藥指南, 2015, 13(21): 146, 147.
51.	張秋學, 張執全, 楊冬山, 等. 脾切除斷流術后早期抗凝預防門靜脈系統血栓形成. 中華普通外科雜志, 2012, 27(4): 302-305.
52.	張振, 王孟龍, 張海濤, 等. 肝硬化門靜脈高壓患者脾切除斷流術后早期門靜脈血栓形成的因素及預防性活血、抗凝、祛聚治療的效果. 肝臟, 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. 鄭波, 廖東旭, 楊訓, 等. 門靜脈高壓性脾功能亢進患者腹腔鏡脾切除術后并發門靜脈系統血栓形成的危險因素研究. 中國普外基礎與臨床雜志, 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. 陳國富, 范國華. 脾切除術后門靜脈系統血栓形成的臨床分析. 中國普外基礎與臨床雜志, 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, ?orniak 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. 羅永香, 勞景茂, 鄭達武, 等. 低分子肝素聯合血栓通預防脾切除術后門靜脈血栓的臨床研究. 中國社區醫師, 2018, 34(13): 55-56.
24. 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.
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, 黃繼超, 安雪霞, 等. 脾切除斷流術后門靜脈血液流變學變化與門靜脈血栓形成關系研究. 中華普通外科雜志, 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. 藥物治療門靜脈系統血栓形成的療效. 溫州醫科大學學報, 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. 梁剛, 王智翔, 何盟國, 等. 早期聯合抗凝對脾切斷流術后門靜脈系統血栓形成的預防效果. 臨床醫學研究與實踐, 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. 鄭春雷, 趙永福, 唐哲, 等. 早期聯合應用抗凝藥物預防脾切斷流術后門靜脈血栓的形成. 世界華人消化雜志, 2015, 23(1): 129-133.
43. 魏俊凌. 急性門靜脈血栓形成的臨床診斷及治療方法研究. 當代醫學, 2014, 20(17): 94-95.
44. 趙東, 李紅春, 陶紅光, 等. 門靜脈血栓形成的臨床診治分析. 中華肝臟外科手術學電子雜志, 2017, 6(1): 45-49.
45. 薛渙洲, 張宏偉, 張穎霞. 門靜脈系統抗凝預防斷流術后門靜脈系血栓形成. 中華外科雜志, 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. 張瑋, 周大明, 李陽. 低分子肝素防治肝硬化及其脾切除術后門靜脈栓塞的系統評價和 Meta 分析. 中華肝臟病雜志, 2016, 24(10): 732-737.
50. 楊世揚, 馬春峰. 脾切除斷流術后早期抗凝預防門靜脈系統血栓形成 50 例分析. 中國醫藥指南, 2015, 13(21): 146, 147.
51. 張秋學, 張執全, 楊冬山, 等. 脾切除斷流術后早期抗凝預防門靜脈系統血栓形成. 中華普通外科雜志, 2012, 27(4): 302-305.
52. 張振, 王孟龍, 張海濤, 等. 肝硬化門靜脈高壓患者脾切除斷流術后早期門靜脈血栓形成的因素及預防性活血、抗凝、祛聚治療的效果. 肝臟, 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

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content