Risk Factors Of Portal Vein Thrombosis After Spleen Resection And Esophagogastric Devascularization In Cirrhosis

Objectives:To identify the risk factors associated with portal vein system thrombosis(PVST)formation after splenectomy and Esophagogastric devascularization in cirrhosis patients and to establish a predictive nomogram.Methods:115 cirrhosis patients who underwent splenectomy and periorbital vascular disconnection in the Second Affiliated Hospital of Nanchang University from June2013 to June 2017 were included retrospectively.These patients were divided into PVST group and non-PVST group according to whether developing postoperative PVE.The general basic data,blood test results and imaging findings of the two groups were analyzed by univariate and multivariate analysis.Moreover,the logistic regression equation and receiver operating characteristic(ROC)curve analysis curve were performed to evaluate the predictive accuracy and net benefit of the nomogram.Results:Univariate analysis showed that the surgical approach(endoscopic/open),splenic vein diameter,hyperlipidemia,and postoperative D-dimer(P<0.05)was associated with PVST.Four risk factors screened were determined by backward analyses.Multivariate analysis showed that the diameter of splenic vein(P<0.05,OR=35.467,AUC=0.922),surgical approach(P<0.05,OR=1.250 AUC=0.662),postoperative D-dimer(P<0.05 OR=1.074 AUC=0.784)were associated the Logit P=-37.187+1.384*X1+3.569*X3+0.071*X4 was performed,and chi-square of fit the development of PVST.The regression equation goodness was 7.220(P >0.05)using Hosmer-kmeshow test equation.Using the cutoff value of highest Gordon index(P=0.177),the accuracy,sensitivity,and specificity were 87.8%,93.85%,and 88.65%respectively.Conclusions:The surgical approach,splenic vein diameter,and postoperative D-dimer are risk factors to PVST formation.The nomogram constructed can accurately predict theformation of PVST.