Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning, People's Republic of China.
Postgraduate College, Jinzhou Medical University, Jinzhou, People's Republic of China.
Adv Ther. 2021 Apr;38(4):1904-1930. doi: 10.1007/s12325-021-01652-7. Epub 2021 Mar 9.
Splenectomy and splenic artery embolization are major treatment options for hypersplenism and portal hypertension in liver cirrhosis, but may lead to splanchnic vein thrombosis (SVT), which is potentially lethal. We conducted a systematic review and meta-analysis to explore the incidence of SVT in liver cirrhosis after splenectomy or splenic artery embolization and the risk factors for SVT.
All relevant studies were searched through the PubMed, EMBASE, and Cochrane Library databases. The incidence of SVT in liver cirrhosis after splenectomy or splenic artery embolization was pooled. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.
Sixty-six studies with 5632 patients with cirrhosis were included. The pooled incidence of SVT after splenectomy and splenic artery embolization was 24.6% (95% CI 20.2-29.3%) and 11.7% (95% CI 7.1-17.3%), respectively. A meta-analysis of three comparative studies demonstrated that the incidence of SVT after splenectomy was statistically similar to that after splenic artery embolization (OR 3.15, P = 0.290). Platelet count, mean platelet volume, preoperative splenic or portal vein diameter, preoperative or postoperative portal blood velocity, splenic volume and weight, and periesophagogastric devascularization were significant risk factors for SVT after splenectomy. Postoperative use of preventive antithrombotic therapy was a significant protective factor against SVT after splenectomy.
SVT is common in liver cirrhosis after splenectomy and splenic artery embolization. Coagulation and hemostasis factors, anatomical factors, and surgery-related factors have been widely identified for the assessment of high risk of SVT after splenectomy. Prophylactic strategy after splenectomy, such as antithrombotic therapy, might be considered in such high-risk patients.
This study was registered in PROSPERO with a registration number of CRD42019129673.
脾切除术和脾动脉栓塞术是肝硬化脾功能亢进和门静脉高压的主要治疗选择，但可能导致肠系膜静脉血栓形成（SVT），这是一种潜在的致命疾病。我们进行了一项系统评价和荟萃分析，以探讨肝硬化患者脾切除术后或脾动脉栓塞术后 SVT 的发生率，以及 SVT 的危险因素。
通过 PubMed、EMBASE 和 Cochrane Library 数据库检索所有相关研究。汇总脾切除术后或脾动脉栓塞术后肝硬化患者 SVT 的发生率。计算优势比（OR）及其 95%置信区间（CI）。
共纳入 66 项研究，共 5632 例肝硬化患者。脾切除术后和脾动脉栓塞术后 SVT 的总发生率分别为 24.6%（95%CI 20.2-29.3%）和 11.7%（95%CI 7.1-17.3%）。对 3 项比较研究的荟萃分析表明，脾切除术后 SVT 的发生率与脾动脉栓塞术无统计学差异（OR 3.15，P=0.290）。血小板计数、血小板平均体积、术前脾静脉或门静脉直径、术前或术后门静脉血流速度、脾脏体积和重量以及胃食管周围血管离断术是脾切除术后 SVT 的显著危险因素。术后预防性抗血栓治疗是脾切除术后预防 SVT 的显著保护因素。
SVT 在肝硬化患者脾切除术后和脾动脉栓塞术后很常见。凝血和止血因素、解剖因素和手术相关因素已广泛用于评估脾切除术后 SVT 的高危风险。在这些高危患者中，脾切除术后可能需要考虑预防性抗血栓治疗策略。
本研究在 PROSPERO 注册，注册号为 CRD42019129673。
