Cho Chan Woo, Park Yang Jin, Kim Young-Wook, Choi Sung Ho, Heo Jin Seok, Choi Dong Wook, Kim Dong-Ik
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2015 Apr;88(4):208-14. doi: 10.4174/astr.2015.88.4.208. Epub 2015 Mar 26.
Acute portal and splenic vein thrombosis (APSVT) after hepatobiliary and pancreatic (HBP) surgery is a rare but serious complication and a treatment strategy has not been well established. To assess the safety and efficacy of anticoagulation therapy for treating APSVT after HBP surgery.
We performed a retrospective case-control study of 82 patients who were diagnosed with APSVT within 4 weeks after HBP surgery from October 2002 to November 2012 at a single institute. We assigned patients to the anticoagulation group (n = 32) or nonanticoagulation group (n = 50) and compared patient characteristics, complications, and the recanalization rate of APSVT between these two groups.
APSVT was diagnosed a mean of 8.6 ± 4.8 days after HBP surgery. Patients' characteristics were not significantly different between the two groups. There were no bleeding complications related to anticoagulation therapy. The 1-year cumulative recanalization rate of anticoagulation group and nonanticoagulation group were 71.4% and 34.1%, respectively, which is statistically significant (log-rank test, P = 0.0001). In Cox regression model for multivariate analysis, independent factors associated with the recanalization rate of APSVT after HBP surgery were anticoagulation therapy (P = 0.003; hazard ration [HR], 2.364; 95% confidence interval [CI], 1.341-4.168), the absence of a vein reconstruction procedure (P = 0.027; HR, 2.557; 95% CI, 1.111-5.885), and operation type (liver resection rather than pancreatic resection; P = 0.005, HR, 2.350; 95% CI, 1.286-4.296).
Anticoagulation therapy appears to be a safe and effective treatment for patients with APSVT after HBP surgery. Further prospective studies of larger patient populations are necessary to confirm our findings.
肝胆胰（HBP）手术后急性门静脉和脾静脉血栓形成（APSVT）是一种罕见但严重的并发症，其治疗策略尚未完全确立。本研究旨在评估抗凝治疗在HBP手术后治疗APSVT的安全性和有效性。
我们对2002年10月至2012年11月在一家机构内HBP手术后4周内被诊断为APSVT的82例患者进行了一项回顾性病例对照研究。我们将患者分为抗凝组（n = 32）和非抗凝组（n = 50），并比较两组患者的特征、并发症以及APSVT的再通率。
APSVT在HBP手术后平均8.6±4.8天被诊断出来。两组患者的特征无显著差异。未出现与抗凝治疗相关的出血并发症。抗凝组和非抗凝组的1年累积再通率分别为71.4%和34.1%，差异具有统计学意义（对数秩检验，P = 0.0001）。在多因素分析的Cox回归模型中，与HBP手术后APSVT再通率相关的独立因素为抗凝治疗（P = 0.003；风险比[HR]，2.364；95%置信区间[CI]，1.341 - 4.168）、未进行静脉重建手术（P = 0.027；HR，2.557；95% CI，1.111 - 5.885）以及手术类型（肝切除而非胰切除；P = 0.005，HR，2.350；95% CI，1.286 - 4.296）。
抗凝治疗似乎是HBP手术后APSVT患者的一种安全有效的治疗方法。需要对更大规模的患者群体进行进一步的前瞻性研究以证实我们的发现。
