Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena 110, 30130-100, Belo Horizonte, Brazil.
Department of Gastroenterology and Hepatology, Hospital da Polícia Militar de Minas Gerais, Belo Horizonte, Brazil.
Trans R Soc Trop Med Hyg. 2021 Sep 3;115(9):1004-1009. doi: 10.1093/trstmh/trab013.
Portal vein thrombosis (PVT) has been described in nearly 50% of patients who underwent oesophagogastric devascularization combined with splenectomy (EGDS), but no previous study has compared its occurrence in surgical and non-surgical groups. This study aimed to investigate PVT in hepatosplenic schistosomiasis (HSS) and its association with EGDS and upper variceal bleeding (UVB).
Retrospectively, 104 HSS individuals were enrolled. Following EGDS, the occurrence of PVT, mesenteric vein thrombosis (MVT), hospital admissions and UVB were recorded.
EGDS was performed in 27 (26%) patients. PVT and MVT were detected in 30 (33%) and 8 (9.8%) patients, respectively. Patients who underwent EGDS were at greater risk of PVT (63% vs 19.7%; odds ratio [OR] 6.12 [95% confidence interval {CI} 2.3 to 16.1], p<0.001) when compared with a non-surgical approach. There was no significant difference in UVB occurrence and β-blocker usage. PVT was associated with more hospital admissions (p=0.030) and higher alkaline phosphatase levels (p=0.008). UVB occurrence in patients with and without thrombosis was similar. In multivariate analysis, after adjustment, PVT was associated with the surgical approach (OR 4.56 [95% CI 1.55 to 13.38], p=0.006) and age at HSS diagnosis (OR 0.94 [95% CI 0.90 to 0.99], p=0.021).
EGDS was not associated with a decreased frequency of UVB when compared with the non-surgical approach but was an independent risk factor for PVT.
在接受食管胃底血管离断术联合脾切除术（EGDS）的患者中，近 50%的患者被描述患有门静脉血栓形成（PVT），但以前没有研究比较过手术组和非手术组的 PVT 发生率。本研究旨在探讨肝脾血吸虫病（HSS）中的 PVT 及其与 EGDS 和上腔静脉出血（UVB）的关系。
回顾性纳入 104 例 HSS 患者。在 EGDS 后，记录 PVT、肠系膜静脉血栓形成（MVT）、住院和 UVB 的发生情况。
27 例（26%）患者接受了 EGDS。30 例（33%）和 8 例（9.8%）患者分别检测到 PVT 和 MVT。与非手术方法相比，接受 EGDS 的患者发生 PVT 的风险更高（63%比 19.7%；优势比[OR]6.12[95%置信区间{CI}2.3 至 16.1]，p<0.001）。UVB 发生和β受体阻滞剂使用无显著差异。PVT 与更多的住院（p=0.030）和更高的碱性磷酸酶水平（p=0.008）相关。有血栓形成和无血栓形成的患者 UVB 发生率相似。多变量分析后，调整其他因素后，PVT 与手术方法（OR 4.56[95%CI 1.55 至 13.38]，p=0.006）和 HSS 诊断时的年龄（OR 0.94[95%CI 0.90 至 0.99]，p=0.021）相关。
与非手术方法相比，EGDS 并不会降低 UVB 的发生频率，但它是 PVT 的独立危险因素。
