Wu Long-Fei, Bai Dou-Sheng, Shi Lin, Jin Sheng-Jie, Zhou Bao-Huan, Jiang Guo-Qing
Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225000, Jiangsu, China.
Department of Hepatobiliary Surgery, The First Clinical College, Dalian Medical University, Dalian, China.
Surg Endosc. 2022 Jun;36(6):4090-4098. doi: 10.1007/s00464-021-08730-5. Epub 2021 Sep 13.
The thrombosis of the main and intrahepatic branches of the portal vein (TMIP) is potentially lethal and deemed a common complication following laparoscopic splenectomy and azygoportal disconnection (LSD) in patients with cirrhosis and portal hypertension (PH). The predictors of TMIP after LSD remain unclear. The aim of this prospective study was to explore the predictive and risk factors for TMIP after LSD in cirrhotic patients with PH caused only by hepatitis B virus.
From September 2014 to March 2017, we enrolled 115 patients with hepatitis B cirrhosis and PH who successfully underwent LSD. Patients were subdivided into a TMIP group and a non-TMIP group. Univariate and multivariate logistic regression analysis was conducted on 24 items of demographic and preoperative data, to explore the risk factors of TMIP.
Twenty-nine (25.22%) patients developed TMIP on postoperative day (POD) 7 and 26 (22.81%) patients developed TMIP on POD 30. From POD 7 to POD 30, 12 patients who did not have TMIP at POD 7 were newly diagnosed with TMIP, with portal vein diameter 15.05 ± 2.58 mm. Another 14 patients in whom TMIP had resolved had portal vein diameter 14.02 ± 1.76 mm. Univariate analysis and multivariate logistic regression revealed that portal vein diameter ≥ 13 mm [relative risk (RR) 5.533, 95% confidence interval (CI) 1.222-25.042; P = 0.026] and portal vein diameter ≥ 15 mm (RR 3.636, 95% CI 1.466-9.021; P = 0.005) were significant independent risk factors for TMIP on POD 7 and 30, respectively.
Portal vein diameter ≥ 13 mm and ≥ 15 mm were significant independent predictors for TMIP after LSD in patients with hepatitis B cirrhosis and PH on POD 7 and POD 30, respectively.
We registered our research at https://www.
gov/ . The name of research registered is "Warfarin Prevents Portal Vein Thrombosis in Patients After Laparoscopic Splenectomy and Azygoportal Disconnection." The trial registration identifier at clinicaltrials.gov is NCT02247414.
门静脉主干及肝内分支血栓形成（TMIP）具有潜在致死性，被认为是肝硬化和门静脉高压（PH）患者行腹腔镜脾切除术和奇静脉-门静脉断流术（LSD）后的常见并发症。LSD术后TMIP的预测因素尚不清楚。本前瞻性研究的目的是探讨仅由乙型肝炎病毒引起的肝硬化合并PH患者LSD术后TMIP的预测因素和危险因素。
2014年9月至2017年3月，我们纳入了115例行LSD成功的乙型肝炎肝硬化合并PH患者。将患者分为TMIP组和非TMIP组。对24项人口统计学和术前数据进行单因素和多因素logistic回归分析，以探讨TMIP的危险因素。
29例（25.22%）患者在术后第7天（POD 7）发生TMIP，26例（22.81%）患者在POD 30发生TMIP。从POD 7到POD 30，12例在POD 7时未发生TMIP的患者新诊断为TMIP，门静脉直径为15.05±2.58mm。另外14例TMIP已缓解的患者门静脉直径为14.02±1.76mm。单因素分析和多因素logistic回归显示，门静脉直径≥13mm[相对危险度（RR）5.533，95%置信区间（CI）1.222 - 25.042；P = 0.026]和门静脉直径≥15mm（RR 3.636，95%CI 1.466 - 9.021；P = 0.005）分别是POD 7和POD 30时TMIP的显著独立危险因素。
门静脉直径≥13mm和≥15mm分别是乙型肝炎肝硬化合并PH患者LSD术后POD 7和POD 30时TMIP的显著独立预测因素。
我们在https://www.CLINICALTRIALS: gov/ 注册了我们的研究。注册的研究名称是“华法林预防腹腔镜脾切除术和奇静脉-门静脉断流术后患者门静脉血栓形成”。clinicaltrials.gov上的试验注册标识符为NCT02247414。
