Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
摘要：
背景：尽管术后门静脉血栓（PVT）是脾切除术的常见并发症，很少有研究检查同时进行肝切除和脾切除（HS）后的PVT。这项研究的目的是阐明HS后PVT的危险因素和特征。
方法：这项回顾性观察研究包括102名患者，包括76例肝硬化（LC）和26例无肝硬化，在2004年4月至2021年4月期间接受了HS。分析术后1周对比增强CT检测到的PVT的发生率和部位。此外,比较术后PVT患者和无术后PVT患者的术前和术中参数，以确定HS后PVT的危险因素。
结果：在102名患者中，29（28.4%），包括使用LC的32.9%和不使用LC的15.4%，术后发生PVT。在29例PVT患者中，21（72.4%），4（13.8%），和4（13.8％）仅在肝内门静脉中出现血栓，仅肝外门静脉，以及肝外和肝内门静脉，分别。多因素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)。
结论：我们的结果表明脾静脉扩张是同时发生HS后PVT的独立危险因素，HS后PVT更频繁地发生在肝内门静脉中。脾静脉扩张病例HS后，无论肝切除类型如何，我们都应特别注意肝内门静脉PVT的发展。
方法：这项回顾性观察研究包括102名患者，包括76例肝硬化（LC）和26例无肝硬化，在2004年4月至2021年4月期间接受了HS。分析术后1周对比增强CT检测到的PVT的发生率和部位。此外,比较术后PVT患者和无术后PVT患者的术前和术中参数，以确定HS后PVT的危险因素。
结果：在102名患者中，29（28.4%），包括使用LC的32.9%和不使用LC的15.4%，术后发生PVT。在29例PVT患者中，21（72.4%），4（13.8%），和4（13.8％）仅在肝内门静脉中出现血栓，仅肝外门静脉，以及肝外和肝内门静脉，分别。多因素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)。
结论：我们的结果表明脾静脉扩张是同时发生HS后PVT的独立危险因素，HS后PVT更频繁地发生在肝内门静脉中。脾静脉扩张病例HS后，无论肝切除类型如何，我们都应特别注意肝内门静脉PVT的发展。
