Division of Gastroenterology, Department of Medicine.
Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Inflamm Bowel Dis. 2020 Jan 6;26(2):283-288. doi: 10.1093/ibd/izz169.
Portomesenteric venous thrombosis (PMVT) is an under-recognized complication of colorectal surgery. The aim of this study was to describe the rate and risk factors for PMVT in patients undergoing surgery for medically refractory ulcerative colitis (UC).
A retrospective review of medically refractory UC patients who underwent surgery between January 2010 and December 2016 at a single tertiary care center was conducted. PMVT was defined as thrombus within the portal, splenic, superior, or inferior mesenteric vein on postoperative abdominal computed tomography scans. Factors associated with PMVT on univariable analysis were tested in multivariable analysis. Clinical relevance of risk factors was examined with receiver operating characteristic curves and Kaplan-Meier curves.
A total of 434 patients were identified. Postoperative venous thromboembolism (VTE) prophylaxis was administered to 428 (98.5%) inpatients for a mean duration of 7.7 ± 0.17 days. PMVT developed in 36 (8.3%) patients a mean interval of 55.3 ± 10.8 days after index surgery. The majority of PMVT occurred after subtotal colectomy, and the most common initial symptom was abdominal pain. Preoperative C-reactive protein (CRP) was associated with PMVT (odds ratio, 1.01; 95% confidence interval, 1.00-1.02; P = 0.01), and the optimal predictive CRP threshold was 45 mg/L. The rate of PMVT development was greater for patients with CRP >45 mg/L (P = 0.01).
PMVT can present as abdominal pain and occur multiple weeks after discharge. Further studies are needed to identify the appropriate postoperative outpatient thrombosis prophylaxis regimen for at-risk patients.
门静脉肠系膜静脉血栓形成（PMVT）是结直肠手术后未被充分认识的并发症。本研究旨在描述接受手术治疗的医学难治性溃疡性结肠炎（UC）患者发生 PMVT 的发生率和危险因素。
对 2010 年 1 月至 2016 年 12 月在一家三级医疗中心接受手术治疗的医学难治性 UC 患者进行了回顾性研究。术后腹部 CT 扫描显示门静脉、脾静脉、肠系膜上静脉或肠系膜下静脉内血栓形成定义为 PMVT。单变量分析中与 PMVT 相关的因素在多变量分析中进行了测试。通过受试者工作特征曲线和 Kaplan-Meier 曲线检查危险因素的临床相关性。
共确定了 434 名患者。428 名住院患者（98.5%）接受了术后静脉血栓栓塞症（VTE）预防治疗，平均持续时间为 7.7±0.17 天。36 名患者（8.3%）在指数手术后平均 55.3±10.8 天出现 PMVT。大多数 PMVT 发生在次全结肠切除术后，最常见的初始症状是腹痛。术前 C 反应蛋白（CRP）与 PMVT 相关（比值比，1.01；95%置信区间，1.00-1.02；P=0.01），最佳预测 CRP 阈值为 45mg/L。CRP>45mg/L 的患者 PMVT 发生率更高（P=0.01）。
PMVT 可表现为腹痛，发生在出院后数周。需要进一步研究以确定高危患者术后门诊血栓预防方案。
