Predictive Factors for Portal Vein Thrombosis after Splenectomy and Gastroesophageal Devascularization_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 KUANGJie , YANGWei-ping , YANJi-qi , MADi ,  CHENHao , PENGCheng-hong , LIHong-wei

Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China;

Corresponding?author：

CHENHao, Email: haochendr@126.com

Keywords：

Portal hypertension; Splenectomy; Gastroesophageal devascularization; Portal venous thrombosis; Prediction; Platelet; Fibrin degradation product

DOI：

10.7507/1007-9424.20150342

Video：

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Objective To investigate the predictive factors of portal vein thrombosis (PVT) before and after splenectomy and gastroesophageal devascularization for liver cirrhosis with portal hypertension. Methods Sixty-one cases of liver cirrhosis with portal hypertension who underwent splenectomy and gastroesophageal devascularization were enrolled retrospectively. The patients were divided into PVT group and non-PVT group based on the presence or absence of postoperative PVT on day 7. The clinical factors related with PVT were analyzed. Results There were 25 cases in the DVT group and 36 cases in the non-DVT group. The results of univariate analysis showed that the preoperative platelet (P=0.006), activated partial thromboplastin time (P=0.048), prothrombin time (P=0.028), and international normalized ratio (P=0.029), postoperative fibrin degradation product (P=0.002) and D-dimer (P=0.014) on day 1, portal venous diameter (P=0.050) had significant differences between the DVT group and non-DVT group. The results of logistic multivariate regression analysis showed that the preoperative platelet (OR=0.966, 95% CI 0.934-1.000, P=0.048) and postoperative fibrin degradation product on day 1(OR=1.055, 95% CI 1.011-1.103, P=0.017) were correlated with the PVT. The PVT might happen when preoperative platelet was less than 34.5×10⁹/L (sensitibity 80.6%, specificity 60.0%) or postoperative fibrin degradation product on day 1 was more than 64.75 mg/L (sensitibity 48.0%, specificity 91.7%). Conclusion Preoperative platelet and postoperative fibrin degradation product on day 1 might predict PVT after splenectomy and gastroesophageal devascularization for liver cirrhosis with portal hypertension.

Citation： KUANGJie, YANGWei-ping, YANJi-qi, MADi, CHENHao, PENGCheng-hong, LIHong-wei. Predictive Factors for Portal Vein Thrombosis after Splenectomy and Gastroesophageal Devascularization. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(11): 1305-1309. doi: 10.7507/1007-9424.20150342 Copy

1.	?Francoz C, Belghiti J, Vilgrain V, et al. Splanchnic vein thrombosis in candidates for liver transplantation:usefulness of screening and anticoagulation. Gut, 2005, 54(5):691-697.
2.	Hanazaki K, Kajikawa S, Adachi W, et al. Portal vein thrombosis may be a fatal complication after synchronous splenectomy in patients with hepatocellular carcinoma and hypersplenism. J Am Coll Surg, 2000, 191(3):341-342.
3.	Manzanet G, Sanjuán F, Orbis P, et al. Liver transplantation in patients with portal vein thrombosis. Liver Transpl, 2001, 7(2):125-131.
4.	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.
5.	Lai W, Lu SC, Li GY, et al. Anticoagulation therapy prevents portalsplenic vein thrombosis after splenectomy with gastroesophageal devascularization. World J Gastroenterol, 2012, 18(26):3443-3450.
6.	匡潔, 楊衛平, 陳皓, 等.早期使用低分子肝素預防門靜脈高壓斷流術后門靜脈血栓形成.外科理論與實踐, 2015, 20(2):131-134.
7.	Kawanaka H, Akahoshi T, Kinjo N, et al. Impact of antithrombinⅢconcentrates on portal vein thrombosis after splenectomy in patients with liver cirrhosis and hypersplenism. Ann Surg, 2010, 251(1):76-83.
8.	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.
9.	Deng MH, Liu B, Fang HP, et al. Predictive value of D-dimer for portal vein thrombosis after portal hypertension surgery in hepatitis B virus-related cirrhosis. World J Gastroenterol, 2007, 13(48):6588-6592.
10.	匡潔, 楊衛平, 陳皓, 等.門靜脈高壓癥術后門靜脈血栓形成的危險因素分析.外科理論與實踐, 2012, 17(6):634-638.
11.	Ikeda M, Sekimoto M, Takiguchi S, et al. Total splenic vein thrombosis after laparoscopic splenectomy:a possible candidate for treatment. Am J Surg, 2007, 193(1):21-25.
12.	Romano F, Caprotti R, Conti M, et al. Thrombosis of the splenoportal axis after splenectomy. Langenbecks Arch Surg, 2006, 391(5):483-488.
13.	Kinjo N, Kawanaka H, Akahoshi T, et al. Risk factors for portal venous thrombosis after splenectomy in patients with cirrhosis and portal hypertension. Br J Surg, 2010, 97(6):910-916.
14.	Kawanaka H, Akahoshi T, Itoh S, et al. Optimizing risk stratification in portal vein thrombosis after splenectomy and its primary prophylaxis with antithrombinⅢconcentrates and danaparoid sodium in liver cirrhosis with portal hypertension. J Am Coll Surg, 2014, 219(5):865-874.
15.	牛秀峰, 高林, 倪家連, 等.脾切除斷流術后經脾靜脈抗凝治療預防早期門靜脈血栓的安全性分析.肝膽胰外科雜志, 2012, 24(1):27-29.
16.	林棟棟, 劉晉寧, 盧實春, 等.門靜脈高壓癥脾切除斷流術后血流動力學變化及其臨床意義.中國實用外科雜志, 2007, 27(8):644-645.
17.	Winslow ER, Brunt LM, Drebin JA, et al. Portal vein thrombosis after splenectomy. Am J Surg, 2002, 184(6):631-636.
18.	Fujita F, Lyass S, Otsuka K, et al. Portal vein thrombosis following splenectomy:identification of risk factors. Am Surg, 2003, 69(11):951-956.
19.	彭濤, 陸才德.門靜脈高壓癥行脾切除術后門靜脈血栓形成的預防及治療新進展.現代實用醫學, 2011, 23(3):355-357.
20.	Zocco MA, Di Stasio E, De Cristofaro R, et al. Thrombotic risk factors in patients with liver cirrhosis:correlation with MELD scoring system and portal vein thrombosis development. J Hepatol, 2009, 51(4):682-689.
21.	孫勇偉, 羅蒙, 陳煒, 等.門靜脈高壓癥外科手術后門靜脈系統血栓形成.外科理論與實踐, 2006, 11(3):198-200.
22.	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.e1.
23.	Kim BK, Han KH, Park JY, et al. A novel liver stiffness measurementbased prediction model for cirrhosis in hepatitis B patients. Liver Int, 2010, 30(7):1073-1081.
24.	李大偉.血漿D-二聚體對腹腔鏡脾切除門奇靜脈斷流術后門靜脈血栓形成的預測意義.中國普通外科雜志, 2014, 23(2):207-211.

1. ?Francoz C, Belghiti J, Vilgrain V, et al. Splanchnic vein thrombosis in candidates for liver transplantation:usefulness of screening and anticoagulation. Gut, 2005, 54(5):691-697.
2. Hanazaki K, Kajikawa S, Adachi W, et al. Portal vein thrombosis may be a fatal complication after synchronous splenectomy in patients with hepatocellular carcinoma and hypersplenism. J Am Coll Surg, 2000, 191(3):341-342.
3. Manzanet G, Sanjuán F, Orbis P, et al. Liver transplantation in patients with portal vein thrombosis. Liver Transpl, 2001, 7(2):125-131.
4. 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.
5. Lai W, Lu SC, Li GY, et al. Anticoagulation therapy prevents portalsplenic vein thrombosis after splenectomy with gastroesophageal devascularization. World J Gastroenterol, 2012, 18(26):3443-3450.
6. 匡潔, 楊衛平, 陳皓, 等.早期使用低分子肝素預防門靜脈高壓斷流術后門靜脈血栓形成.外科理論與實踐, 2015, 20(2):131-134.
7. Kawanaka H, Akahoshi T, Kinjo N, et al. Impact of antithrombinⅢconcentrates on portal vein thrombosis after splenectomy in patients with liver cirrhosis and hypersplenism. Ann Surg, 2010, 251(1):76-83.
8. 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.
9. Deng MH, Liu B, Fang HP, et al. Predictive value of D-dimer for portal vein thrombosis after portal hypertension surgery in hepatitis B virus-related cirrhosis. World J Gastroenterol, 2007, 13(48):6588-6592.
10. 匡潔, 楊衛平, 陳皓, 等.門靜脈高壓癥術后門靜脈血栓形成的危險因素分析.外科理論與實踐, 2012, 17(6):634-638.
11. Ikeda M, Sekimoto M, Takiguchi S, et al. Total splenic vein thrombosis after laparoscopic splenectomy:a possible candidate for treatment. Am J Surg, 2007, 193(1):21-25.
12. Romano F, Caprotti R, Conti M, et al. Thrombosis of the splenoportal axis after splenectomy. Langenbecks Arch Surg, 2006, 391(5):483-488.
13. Kinjo N, Kawanaka H, Akahoshi T, et al. Risk factors for portal venous thrombosis after splenectomy in patients with cirrhosis and portal hypertension. Br J Surg, 2010, 97(6):910-916.
14. Kawanaka H, Akahoshi T, Itoh S, et al. Optimizing risk stratification in portal vein thrombosis after splenectomy and its primary prophylaxis with antithrombinⅢconcentrates and danaparoid sodium in liver cirrhosis with portal hypertension. J Am Coll Surg, 2014, 219(5):865-874.
15. 牛秀峰, 高林, 倪家連, 等.脾切除斷流術后經脾靜脈抗凝治療預防早期門靜脈血栓的安全性分析.肝膽胰外科雜志, 2012, 24(1):27-29.
16. 林棟棟, 劉晉寧, 盧實春, 等.門靜脈高壓癥脾切除斷流術后血流動力學變化及其臨床意義.中國實用外科雜志, 2007, 27(8):644-645.
17. Winslow ER, Brunt LM, Drebin JA, et al. Portal vein thrombosis after splenectomy. Am J Surg, 2002, 184(6):631-636.
18. Fujita F, Lyass S, Otsuka K, et al. Portal vein thrombosis following splenectomy:identification of risk factors. Am Surg, 2003, 69(11):951-956.
19. 彭濤, 陸才德.門靜脈高壓癥行脾切除術后門靜脈血栓形成的預防及治療新進展.現代實用醫學, 2011, 23(3):355-357.
20. Zocco MA, Di Stasio E, De Cristofaro R, et al. Thrombotic risk factors in patients with liver cirrhosis:correlation with MELD scoring system and portal vein thrombosis development. J Hepatol, 2009, 51(4):682-689.
21. 孫勇偉, 羅蒙, 陳煒, 等.門靜脈高壓癥外科手術后門靜脈系統血栓形成.外科理論與實踐, 2006, 11(3):198-200.
22. 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.e1.
23. Kim BK, Han KH, Park JY, et al. A novel liver stiffness measurementbased prediction model for cirrhosis in hepatitis B patients. Liver Int, 2010, 30(7):1073-1081.
24. 李大偉.血漿D-二聚體對腹腔鏡脾切除門奇靜脈斷流術后門靜脈血栓形成的預測意義.中國普通外科雜志, 2014, 23(2):207-211.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Predictive Factors for Portal Vein Thrombosis after Splenectomy and Gastroesophageal Devascularization

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