Influencing factors of portal vein thrombosis after splenectomy in patients with cirrhotic hyperplenism

doi:10.3877/cma.j.issn.2095-3232.2024.01.008

Abstract

Abstract:

Objective

To investigate the risk factors of portal vein thrombosis (PVT) after splenectomy in patients with cirrhotic hyperplenism.

Methods

Clinical data of 136 cirrhosis patients complicated with hypersplenism who underwent splenectomy in the Third Affiliated Hospital of Sun Yat-senUniversity from July 2016 to April 2019 were retrospectively analyzed. Among them, 101 patients were male and 35 female, aged (48±11) years on average. 113 cases were diagnosed with viral hepatitis and 8 cases of hepatolenticular degeneration. The informed consents of all patients were obtained and the local ethical committee approval was received. According to postoperative incidence of PVT, all patients were divided into the PVT (n=77) and non-PVT groups (n=59). Clinical indexes were collected during perioperative period. The risk factors of PVT were analyzed by univariate and multivariate Logistic regression analyses, and the optimal diagnostic threshold values of risk factors were analyzed by the ROC curve.

Results

The incidence of PVT was 57%(77/136) after splenectomy in patients with cirrhotic hyperplenism, and 75%(58/136) occurred within 10 d after splenectomy. Univariate analysis showed that endoscopic treatment history, preoperative thrombin time (TT), splenic maximum diameter, splenic intercostal thickness, portal vein diameter, preoperative splenic vein diameter and postoperative portal vein diameter, RBC on the day of surgery and 5-6 d after surgery, Plt on the day of surgery, and TT on 2-4 d after surgery were correlated with the incidence of postoperative PVT (P<0.05). Multivariate Logistic analysis showed that endoscopic treatment history, Plt on the day of surgery, and portal vein diameter were the independent factors influencing the incidence of postoperative PVT (OR=3.556, 1.020, 1.449; P<0.05). ROC curve revealed that the sensitivity and specificity of Plt>62×10⁹/L on the day of surgery in the diagnosis of postoperative PVT were 0.597 and 0.593. The sensitivity and specificity of postoperative portal vein diameter>13.5 mm in the diagnosis of postoperative PVT were 0.390 and 0.864.

Conclusions

The incidence of PVT after splenectomy in patients with cirrhotic hyperplenism is relatively high. Postoperative portal vein diameter>13.5 mm, Plt>62×10⁹/L on the day of surgery and endoscopic treatment history are the independent risk factors for PVT after splenectomy.

Key words: Portal vein thrombosis, Liver cirrhosis, Splenectomy, Hypersplenism, Risk factors, Diameter of portal vein, Platelet

Rishun Su, Yi Lu, Baoding Zhuang, Yi Zhang, Yanjie Li, Jianliang Xu. Influencing factors of portal vein thrombosis after splenectomy in patients with cirrhotic hyperplenism[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(01): 39-44.

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References 41

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因素	PVT组	非PVT组	统计值	P值
内镜治疗史（例）	44	15	χ²=13.68	<0.001
术前TT [s，M（Q₁，Q₃）]	17.3（16.5，17.8）	17.6（17.2，18.4）	Z=-2.50	0.012
脾脏长径[mm，M（Q₁，Q₃）]	178（163，201）	172（156，180）	Z=2.34	0.019
脾肋间厚径[mm，M（Q₁，Q₃）]	63（55，71）	59（53，64）	Z=2.42	0.016
术前门静脉内径[mm，M（Q₁，Q₃）]	14（13，16）	13（10，14）	Z=3.31	0.001
术前脾静脉内径[mm，M（Q₁，Q₃）]	12（10，14）	11（9，12）	Z=2.58	0.009
术后门静脉内径（mm，±s）	13.3±2.5	12.1±1.5	t=3.20	0.002
手术当天RBC（×10¹²/L，±s）	4.1±0.8	3.8±0.8	t=-2.31	0.022
手术当天Plt [×10⁹/L，M（Q₁，Q₃）]	66（49，87）	57（42，71）	Z=2.27	0.023
术后第5～6 d RBC（×10¹²/L，±s）	3.7±0.9	3.5±0.8	t=2.33	0.021
术后第2～4 d TT [s，M（Q₁，Q₃）]	14.9（14.3，15.8）	15.5（14.9，16.2）	Z=-2.88	0.004

因素	PVT组	非PVT组	统计值	P值
内镜治疗史（例）	44	15	χ²=13.68	<0.001
术前TT [s，M（Q₁，Q₃）]	17.3（16.5，17.8）	17.6（17.2，18.4）	Z=-2.50	0.012
脾脏长径[mm，M（Q₁，Q₃）]	178（163，201）	172（156，180）	Z=2.34	0.019
脾肋间厚径[mm，M（Q₁，Q₃）]	63（55，71）	59（53，64）	Z=2.42	0.016
术前门静脉内径[mm，M（Q₁，Q₃）]	14（13，16）	13（10，14）	Z=3.31	0.001
术前脾静脉内径[mm，M（Q₁，Q₃）]	12（10，14）	11（9，12）	Z=2.58	0.009
术后门静脉内径（mm，±s）	13.3±2.5	12.1±1.5	t=3.20	0.002
手术当天RBC（×10¹²/L，±s）	4.1±0.8	3.8±0.8	t=-2.31	0.022
手术当天Plt [×10⁹/L，M（Q₁，Q₃）]	66（49，87）	57（42，71）	Z=2.27	0.023
术后第5～6 d RBC（×10¹²/L，±s）	3.7±0.9	3.5±0.8	t=2.33	0.021
术后第2～4 d TT [s，M（Q₁，Q₃）]	14.9（14.3，15.8）	15.5（14.9，16.2）	Z=-2.88	0.004

变量	b	SE（b）	Wald χ²	OR	95%CI	P
内镜治疗史	1.271	0.401	9.998	3.556	1.621～7.843	0.001
手术当天Plt	0.200	0.008	5.783	1.020	1.004～1.037	0.016
术后门静脉内径	0.371	0.115	10.329	1.449	1.156～1.816	0.002

变量	b	SE（b）	Wald χ²	OR	95%CI	P
内镜治疗史	1.271	0.401	9.998	3.556	1.621～7.843	0.001
手术当天Plt	0.200	0.008	5.783	1.020	1.004～1.037	0.016
术后门静脉内径	0.371	0.115	10.329	1.449	1.156～1.816	0.002

危险因素	AUC	P	95%CI	最佳界值
手术当天Plt	0.614	0.023	0.519～0.708	62×10⁹/L
术后门静脉内径	0.653	0.002	0.561～0.744	13.5 mm

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