Fukuta Atsuhisa, Matsuura Toshiharu, Uchida Yasuyuki, Kawakubo Naonori, Kondo Takuya, Takahashi Yoshiaki, Yoshimaru Koichiro, Nagata Kouji, Tajiri Tatsuro
Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
Pediatr Surg Int. 2025 Aug 29;41(1):276. doi: 10.1007/s00383-025-06171-y.
This study aimed to identify predictors of portal vein thrombosis (PVT) after laparoscopic splenectomy (LS) in children.
Patients who underwent LS between September 2014 and August 2024 were retrospectively reviewed. Preoperative and intraoperative clinical data were compared between those with and without PVT. The splenic vein diameter (SVD) was measured at 2, 4, and 6 cm from the portal vein (PV) junction using preoperative transaxial computed tomography images.
Among 21 patients who underwent LS, those with PVT were significantly older, more likely to be female, and had a higher body mass index. Although splenic maximum diameter, PV diameter, and the spleen volume/standard spleen volume ratio showed no significant differences, SVD was significantly larger at all measured locations in patients with PVT. Additionally, the SVD/portal vein diameter (PVD) ratio was significantly higher at all measured locations in these patients. Receiver operating characteristic analysis identified the SVD/PVD ratio as the most reliable predictor of PVT development, with an optimal cutoff value of 0.7.
An SVD/PVD ratio ≥ 0.7 is a strong predictor of PVT after LS in children. Measuring this ratio preoperatively may identify high-risk patients, allowing for closer monitoring and potential preventive interventions to reduce PVT incidence.
本研究旨在确定儿童腹腔镜脾切除术后门静脉血栓形成（PVT）的预测因素。
回顾性分析2014年9月至2024年8月期间接受腹腔镜脾切除术的患者。比较有和没有PVT患者的术前和术中临床数据。使用术前横轴位计算机断层扫描图像，在距门静脉（PV）汇合处2、4和6厘米处测量脾静脉直径（SVD）。
在21例接受腹腔镜脾切除术的患者中，发生PVT的患者年龄显著更大，更可能为女性，且体重指数更高。尽管脾最大直径、PV直径以及脾脏体积/标准脾脏体积比无显著差异，但PVT患者在所有测量位置的SVD均显著更大。此外，这些患者在所有测量位置的SVD/门静脉直径（PVD）比均显著更高。受试者工作特征分析确定SVD/PVD比是PVT发生最可靠的预测因素，最佳截断值为0.7。
SVD/PVD比≥0.7是儿童腹腔镜脾切除术后PVT的有力预测因素。术前测量该比值可能识别出高危患者，从而进行更密切的监测并采取潜在的预防干预措施以降低PVT发生率。
