Wei Qiang, Mei Shengmin, Fu Zhifei, Wang Xiaodong, Han Chengzuo, Chen Jun, Liu Peng, Chen Bin, Fang Xin, Jia Changku, Zheng Shusen, Xu Xiao
The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310006, China.
Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China.
Heliyon. 2022 Dec 19;8(12):e12482. doi: 10.1016/j.heliyon.2022.e12482. eCollection 2022 Dec.
BACKGROUND/AIM: Portal vein system thrombosis (PVST) is a serious complication after splenectomy, and many researches focus on how to prevent PVST these years. The current study aimed to explore an effectively method to prevent PVST occur after splenectomy.
Records of patients performed with splenectomy from January 2018 to December 2020 were reviewed. Clinical parameters, including patient history, physical examination, and the results of laboratory investigations, were analyzed.
One hundred and eighty patients (127 females) were included. Twenty-four patients were confirmed PVST by Color Doppler ultrasonography and CTA (thrombus group) and the others were not (non-thrombus group). One hundred and twenty patients were performed with laparoscopic splenectomy (LS) and 53 were open splenectomy (OS). Seventeen PVST were found in LS patients and 7 PVST were found in OS patients (P = 0.974). The average time of thrombosis was 4.48 ± 2.9 days after operation. The proportion of postoperative preventive use of low molecular weight heparin (LMWH) in non-thrombus group was higher than that in thrombus group (27.6% vs. 8.3%, = 0.045). Compared with the non-thrombus group, the thrombus group showed significantly higher serum alanine transaminase (ALT) and aspartate transaminase (AST) 7 days after splenectomy (79.67 ± 39.1 U/L vs. 29.34 ± 2.5 U/L, P = 0.001; 192.4 ± 145.8 U/L vs. 30.54 ± 3.0 U/L, P < 0.001).
Laparoscopic splenectomy does not seem to increase the occurrence of PVST in patients without portal hypertension. Early postoperative preventive use of LMWH after splenectomy may prevent the formation of PVST.
背景/目的：门静脉系统血栓形成（PVST）是脾切除术后的一种严重并发症，近年来许多研究聚焦于如何预防PVST。本研究旨在探索一种有效预防脾切除术后PVST发生的方法。
回顾2018年1月至2020年12月行脾切除术患者的记录。分析临床参数，包括患者病史、体格检查及实验室检查结果。
纳入180例患者（127例女性）。24例经彩色多普勒超声和CTA确诊为PVST（血栓组），其余患者未发生（非血栓组）。120例行腹腔镜脾切除术（LS），53例行开放性脾切除术（OS）。LS患者中发现17例PVST，OS患者中发现7例PVST（P = 0.974）。血栓形成的平均时间为术后4.48±2.9天。非血栓组术后预防性使用低分子肝素（LMWH）的比例高于血栓组（27.6%对8.3%，P = 0.045）。与非血栓组相比，血栓组脾切除术后7天血清丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）显著更高（79.67±39.1 U/L对29.34±2.5 U/L，P = 0.001；192.4±145.8 U/L对30.54±3.0 U/L，P < 0.001）。
腹腔镜脾切除术似乎不会增加无门静脉高压患者PVST的发生率。脾切除术后早期预防性使用LMWH可能预防PVST的形成。
