Risk factors for portal vein thrombosis after splenectomy in hepatolenticular degeneration patients complicated with hypersplenism

doi:10.3877/cma.j.issn.1672-6448.2022.08.016

Abstract

Abstract:

Objective

To identify the high risk factors of perioperative portal venous thrombosis (PVST) in patients with hepatolenticular degeneration (HLD) after splenectomy.

Methods

A total of 60 patients with hypersplenism secondary to HLD at the first Affiliated Hospital of Anhui University of Chinese Medicine from November 2017 to June 2020 were selected for splenectomy. They were divided into two groups according to whether PVST was present after splenectomy. The maximum thickness of the spleen, inner diameter of the portal vein, and maximum blood flow velocity were measured and recorded before splenectomy. Blood embolism in the posterior splenic vein and portal vein was observed on the 7th day after the operation. Multivariate logistic regression was used to analyze the risk factors of PVST in patients with HLD secondary hypersplenism after splenectomy, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of different risk factors for PVST.

Results

The portal vein diameter (P=0.019), portal vein flow velocity (P=0.012), and spleen volume (P=0.045) were identified to be risk factors for portal vein thrombosis after splenectomy. The area under the curve of combined portal vein diameter, portal vein flow velocity, and splenic volume in predicting the incidence of portal vein thrombosis was 0.831.

Conclusion

Color Doppler ultrasound can detect and monitor PVST during the perioperative period after splenectomy in patients with HLD. Preoperative portal vein diameter, portal vein blood flow velocity, and intraoperative spleen volume are the high risk factors for PVST.

Key words: Ultrasonography, Doppler, Color, Hepatolenticular degeneration, Splenectomy, Portal vein thrombosis

Baoqi Li, Jiajia Wang, Jinping Wang, Hongbing Wu. Risk factors for portal vein thrombosis after splenectomy in hepatolenticular degeneration patients complicated with hypersplenism[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(08): 818-822.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2022.08.016

https://chaosheng.cma-cmc.com.cn/EN/Y2022/V19/I08/818

Figures/Tables 7

参数	PVST组（n=30）	无PVST组（n=30）	统计值	P值
男性［例（%）］	17（56.7）	12（40.0）	χ²=0.510	0.434
年龄（岁， $x ¯$ ±s）	27.4±9.2	29.5±12.1	t=0.962	0.074
吸烟史［例（%）］	1（3.3）	0	χ²=0.381	0.912
糖尿病史［例（%）］	0	2（6.7）	χ²=0.463	0.765
高血压病史［例（%）］	1（3.3）	0	χ²=0.381	0.912
术前PLT计数（×10⁹/L， $x ¯$ ±s）	47.5±18.0	54.8±32.7	t=0.953	0.099
术前凝血酶原时间（s， $x ¯$ ±s）	15.4±2.9	14.8±2.9	t=0.561	0.827
门静脉内径（mm， $x ¯$ ±s）	14.1±2.4	12.3±1.7	t=8.913	0.016
门静脉血流速度（cm/s， $x ¯$ ±s）	15.0±4.5	18.6±5.0	t=10.131	0.013
脾脏厚度（mm， $x ¯$ ±s）	63.7±11.1	58.8±10.8	t=0.619	0.982
术中脾脏体积（ml， $x ¯$ ±s）	3208.7±3486.2	2622.2±2135.6	t=25.123	0.001
术后PLT计数（×10⁹/L， $x ¯$ ±s）	397.5±178.8	307.4±217.7	t=14.983	0.012
术后凝血酶原时间（s， $x ¯$ ±s）	16.3±3.2	14.57±2.3	t=5.163	0.206

参数	PVST组（n=30）	无PVST组（n=30）	统计值	P值
男性［例（%）］	17（56.7）	12（40.0）	χ²=0.510	0.434
年龄（岁， $x ¯$ ±s）	27.4±9.2	29.5±12.1	t=0.962	0.074
吸烟史［例（%）］	1（3.3）	0	χ²=0.381	0.912
糖尿病史［例（%）］	0	2（6.7）	χ²=0.463	0.765
高血压病史［例（%）］	1（3.3）	0	χ²=0.381	0.912
术前PLT计数（×10⁹/L， $x ¯$ ±s）	47.5±18.0	54.8±32.7	t=0.953	0.099
术前凝血酶原时间（s， $x ¯$ ±s）	15.4±2.9	14.8±2.9	t=0.561	0.827
门静脉内径（mm， $x ¯$ ±s）	14.1±2.4	12.3±1.7	t=8.913	0.016
门静脉血流速度（cm/s， $x ¯$ ±s）	15.0±4.5	18.6±5.0	t=10.131	0.013
脾脏厚度（mm， $x ¯$ ±s）	63.7±11.1	58.8±10.8	t=0.619	0.982
术中脾脏体积（ml， $x ¯$ ±s）	3208.7±3486.2	2622.2±2135.6	t=25.123	0.001
术后PLT计数（×10⁹/L， $x ¯$ ±s）	397.5±178.8	307.4±217.7	t=14.983	0.012
术后凝血酶原时间（s， $x ¯$ ±s）	16.3±3.2	14.57±2.3	t=5.163	0.206

因素	β	SE	Wald值	P值	OR值	95%CI
门静脉内径	0.826	0.353	5.476	0.019	2.284	1.144~4.560
门静脉血流速度	-0.334	0.133	6.317	0.012	0.716	0.552~0.929
脾脏体积	0.006	0.003	4.032	0.045	1.006	1.000~1.011

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