Katano Kaoru, Nakanuma Shinichi, Araki Takahiro, Kato Kazuki, Sugita Hiroaki, Gabata Ryosuke, Tokoro Tomokazu, Takei Ryohei, Kato Kaichiro, Takada Satoshi, Okazaki Mitsuyoshi, Toyama Tadashi, Makino Isamu, Yagi Shintaro
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
Department of Nephrology and Laboratory Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan; Innovative Clinical Research Center, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
Asian J Surg. 2024 Dec;47(12):5137-5142. doi: 10.1016/j.asjsur.2024.07.131. Epub 2024 Jul 25.
Although postoperative portal vein thrombosis (PVT) is a frequent complication of splenectomy, few studies have examined PVT after simultaneous hepatectomy and splenectomy (HS). The aim of this study was to clarify the risk factors for and characteristics of PVT after HS.
This retrospective observational study included 102 patients, including 76 with liver cirrhosis (LC) and 26 without, who underwent HS between April 2004 and April 2021. The incidence and location of postoperative PVT detected on contrast-enhanced CT 1 week after surgery were analyzed. In addition, pre- and intraoperative parameters were compared between patients with postoperative PVT and those without in order to determine risk factors for PVT after HS.
Among the 102 patients, 29 (28.4 %), including 32.9 % with LC and 15.4 % without LC, developed PVT after surgery. Among the 29 patients with PVT, 21 (72.4 %), 4 (13.8 %), and 4 (13.8 %) developed thrombus in the intrahepatic portal vein only, extrahepatic portal vein only, and both the extra- and intrahepatic portal veins, respectively. Multivariable analysis showed that preoperative splenic vein dilatation was an independent risk factor for PVT after HS (odds ratio: 1.53, 95 % confidence interval: 1.156-2.026, P = 0.003).
Our results suggest that splenic vein dilatation is an independent risk factor for PVT after simultaneous HS, and that PVT after HS occurs more frequently in the intrahepatic portal vein. After HS for cases with dilated splenic veins, we should pay particular attention to the PVT development in the intrahepatic portal vein regardless of the type of liver resection.
尽管术后门静脉血栓形成（PVT）是脾切除术常见的并发症，但很少有研究探讨同期肝切除术和脾切除术（HS）后的PVT情况。本研究旨在明确HS后PVT的危险因素及特征。
本回顾性观察性研究纳入了2004年4月至2021年4月期间接受HS的102例患者，其中76例有肝硬化（LC），26例无肝硬化。分析术后1周增强CT检测到的术后PVT的发生率和部位。此外，比较术后发生PVT的患者和未发生PVT的患者术前及术中参数，以确定HS后PVT的危险因素。
102例患者中，29例（28.4%）术后发生PVT，其中有LC的患者占32.9%，无LC的患者占15.4%。在29例发生PVT的患者中，仅肝内门静脉形成血栓的有21例（72.4%），仅肝外门静脉形成血栓的有4例（13.8%），肝内和肝外门静脉均形成血栓的有4例（13.8%）。多变量分析显示，术前脾静脉扩张是HS后PVT的独立危险因素（比值比：1.53，95%置信区间：1.156 - 2.026，P = 0.003）。
我们的结果表明，脾静脉扩张是同期HS后PVT的独立危险因素，且HS后PVT更常发生于肝内门静脉。对于脾静脉扩张的病例行HS后，无论肝切除类型如何，我们都应特别关注肝内门静脉PVT的发生。
