Rottenstreich Amihai, Kleinstern Geffen, Spectre Galia, Da'as Nael, Ziv Esther, Kalish Yosef
Department of Hematology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel.
Braun School of Public Health and Community Medicine, Faculty of Medicine of the Hebrew University and Hadassah, Jerusalem, Israel.
World J Surg. 2018 Mar;42(3):675-681. doi: 10.1007/s00268-017-4185-2.
Thromboembolic events following splenectomy are not uncommon. However, the role of thromboprophylaxis and risk factors for thrombosis, as well as the clinical course and outcomes, are not well characterized.
A retrospective review of individuals who underwent splenectomy between January 2006 and December 2015 in two university hospitals.
Overall, 297 patients underwent splenectomy [open splenectomy (n = 199), laparoscopic splenectomy (n = 98)]. Mechanical (thigh-length pneumatic compression stockings) and pharmacologic thromboprophylaxis (40 mg enoxaparin daily, starting 12 h after surgery until discharge) was provided for all patients. One hundred and sixteen patients (39%) also received an extended thromboprophylaxis course of enoxaparin for 2-4 weeks after discharge. Twenty-three patients (7.7%) experienced thrombotic complications following splenectomy, including 16 cases (5.4%) of portal-splenic mesenteric venous thrombosis (PSMVT), 5 (1.7%) pulmonary embolism and 2 (0.7%) deep vein thrombosis. Longer operative time (mean operative time of 405 vs. 273 min, P = 0.03) was independently associated with PSMVT. Post-splenectomy thrombocytosis was not associated with thrombosis (P = 0.41). The overall thrombosis rate was significantly lower in patients who received an extended thromboprophylaxis course following splenectomy (3.4 vs. 10.5%, P = 0.02). Complete resolution of thrombosis was observed in most cases (n = 20, 87.0%), with no recurrent thrombosis during a mean follow-up of 38 ± 25 months.
Thromboembolic complications, mainly PSMVT, are common following splenectomy. Longer operative time was associated with thrombosis. Significantly lower rates of thrombosis were found in patients who received an extended thromboprophylaxis course.
脾切除术后的血栓栓塞事件并不少见。然而，血栓预防的作用、血栓形成的危险因素以及临床病程和结局尚未得到充分描述。
对2006年1月至2015年12月期间在两家大学医院接受脾切除术的患者进行回顾性研究。
总体而言，297例患者接受了脾切除术[开放性脾切除术（n = 199），腹腔镜脾切除术（n = 98）]。所有患者均接受了机械性（大腿长度的气动压迫袜）和药物性血栓预防（术后12小时开始每天40毫克依诺肝素，直至出院）。116例患者（39%）在出院后还接受了为期2 - 4周的延长依诺肝素血栓预防疗程。23例患者（7.7%）在脾切除术后出现血栓并发症，包括16例（5.4%）门静脉 - 脾肠系膜静脉血栓形成（PSMVT）、5例（1.7%）肺栓塞和2例（0.7%）深静脉血栓形成。手术时间较长（平均手术时间405分钟对273分钟，P = 0.03）与PSMVT独立相关。脾切除术后血小板增多症与血栓形成无关（P = 0.41）。接受脾切除术后延长血栓预防疗程的患者总体血栓形成率显著较低（3.4%对10.5%，P = 0.02）。大多数病例（n = 20，87.0%）的血栓形成完全缓解，在平均38 ± 25个月的随访期间无复发性血栓形成。
血栓栓塞并发症，主要是PSMVT，在脾切除术后很常见。手术时间较长与血栓形成有关。接受延长血栓预防疗程的患者血栓形成率显著较低。
