Multivariate Analysis Of Portal Vein Thrombosis After Devascularization

Objective By comparing and analysing the incidence of portal vein thrombosis inpatients of cirrhotic portal hypertension after devascularization in our hospital fromJanuary2010to August2013, we evaluate Various factors of portal vein thrombosis.Methods By preoperative diagnosis of cirrhosis and portal hypertension,excluding::(1) patients of cirrhosis with liver cancer, stomach cancer, pancreatic cancer and othermalignancies;(2) patients with a history of other abdominal surgery;(3) patients of cirrhosis withthe immune system diseases;(4) patients of cirrhosis with blood diseases;(5) patients withpreoperative portal vein thrombosis. There are86cases of patients with cirrhosis and portalhypertension devascularization from January2010to August2013in our hospital, of which47males and39females, aged37-72years old, with a median age of53years old, liver functionChild-Pugh score grade A48cases, grade B38cases.,preoperative upper gastrointestinal endoscopyand barium meal examination were confirmed moderate to severe esophageal varices, and havesignificant splenomegaly and hypersplenism.. Preoperative treatment were carried to correct anemia,hypoalbuminemia, coagulopathy, etc. According to preoperative imaging data,we dicide to performsplenectomy and devascularization(46cases)or selective devascularization(40cases). Portal pressurewere measured in the beginning and in the end.we did the operations carefully and did not use drugsto stop bleeding. Preoperative and postoperative days1,3,5,7, we performed blood, liver function,coagulation tests. Preoperative and postoperative week, two weeks, three weeks,one month,,performed color Doppler ultrasound examination, if necessary, or CTA.Results There were total29cases of portal vein thrombosis diagnosed by color doppler ultrasound examination to obtain,10cases detected after1week,15casesdetected in two weeks, four cases detected after3weeks. There were17cases(58.6%) withirregular or persistent fever of unknown cause, body temperature of38.1℃~39.2℃, continued12~48d..6cases (20.7%) had abdominal distension, abdominal pain discomfort, nausea and othernon-specific symptoms.,3cases (10.3%) with ascites and subside slowly increase, other3cases(10.3%) without obvious symptoms. Sex, post toperation PT time was no statistical differencebetween the groups （P>0.05）. Age, level of liver function (Child-Pugh), preoperative patients withesophageal and gastric varices, the difference between groups was statistically significant（P<0.05）.Portal vein diameter difference between the groups was statistically significant （P<0.05）, studieshad shown that the diameter of the portal vein thrombosis group was significantly widenedcompared with non-thrombotic. Comparison of preoperative portal vein blood flow velocity was nosignificant difference between the groups (P>0.05). Portal vein blood flow velocity differencebetween the groups was statistically significant (P <0.05). In this study, patients with platelet peakedat about two weeks, and thereafter began to decline, in patients with platelet values in the two weeksbetween the groups was statistically significant difference (P <0.05). Patients with different surgicaloptions in the difference between groups was statistically significant (P <0.05).Conclusions Portal vein thrombosis occurs with age, liver function, esophageal andgastric varices, portal vein diameter surgery, postoperative portal vein blood flowvelocity, postoperative platelet value of the underlying.Through the study there werestatistically significant differences between the thrombotic group and non-thromboticgroup. In clinical work, we should pay attention to these factors and take appropriatepreventive and therapeutic measures to reduce the incidence of thrombosis.