Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan.
Department of Gastrointestinal Surgery, Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan.
Langenbecks Arch Surg. 2021 May;406(3):781-789. doi: 10.1007/s00423-021-02125-9. Epub 2021 Feb 27.
Portal vein thrombosis (PVT) following hepatectomy is potentially life-threatening. We aimed to evaluate the incidence of PVT after hepatectomy for hepatocellular carcinoma and identify coagulation and fibrinolytic factors that could predict early-stage postoperative PVT.
A retrospective analysis was conducted on 65 hepatocellular carcinoma patients who underwent radical hepatectomy. The risk factors for postoperative PVT were identified based on univariate and multivariate analyses, and the levels of coagulation and fibrinolytic factors were measured during the perioperative period.
The incidence of PVT after hepatectomy was 20.0%. The patients were divided into two groups: those with PVT (n=13; PVT group) and those without PVT (n=52; no-PVT group). The frequency of the use of the Pringle maneuver during surgery was higher in the PVT group than in the no-PVT group, and the postoperative/preoperative ratios of thrombin-antithrombin III complex (TAT) and of D-dimer were significantly higher in the PVT group.
A high incidence of PVT was found in hepatocellular carcinoma patients after hepatectomy. The frequency of the Pringle maneuver is a potential risk factor for postoperative PVT, and the postoperative/preoperative TAT and D-dimer ratios may be used as early predictors of PVT after hepatectomy for hepatocellular carcinoma.
肝切除术后门静脉血栓形成（PVT）可能危及生命。本研究旨在评估肝癌肝切除术后 PVT 的发生率，并确定可能预测早期术后 PVT 的凝血和纤溶因子。
对 65 例行根治性肝切除术的肝癌患者进行回顾性分析。基于单因素和多因素分析确定术后 PVT 的危险因素，并在围手术期测量凝血和纤溶因子的水平。
肝切除术后 PVT 的发生率为 20.0%。患者分为两组：PVT 组（n=13）和无 PVT 组（n=52）。PVT 组术中使用 Pringle 手法的频率高于无 PVT 组，PVT 组术后/术前凝血酶-抗凝血酶 III 复合物（TAT）和 D-二聚体比值明显更高。
肝癌患者肝切除术后 PVT 发生率较高。Pringle 手法的使用频率是术后 PVT 的潜在危险因素，术后/术前 TAT 和 D-二聚体比值可作为肝癌肝切除术后 PVT 的早期预测指标。
