On Clinical Research Of Portal Vein Thrombosis After Portal Hypertension Devascularization

Objective: To analyze the relevant risk factors, prevention and treatmentmeasures of early portal vein thrombosis, we research the portal hypertension andsplenectomy porta-azygous devascularization.Methods: A total of135patients who underwent simple splenectomy at theacute abdomen surgery of Dalian Freandship Hospital between2002and2012. Theclinical data of85patients underwent portal hypertension splenectomy porta-azygousdevascularization, while58patients are male and27patients are female. A total of19patients demonstrated portal vein thrombosis, while16patients are male and3patientsare female.The other66patients demonstrated non-portal vein thrombosis, while42patients are male and24patients are female. The clinical data of50patients with atrauma of splenectomy,all of them,2patients with portal vein thrombosis.With thelogistic regression analysis method, we analyse patients about age, sex, blood pressure,diabetes, heart disease and others, and Child-Pugh(containing Serum total bilirubin,albumin, prothrombin extension of time, ascites and hepatic encephalopathy), Whetherto use drugs to stop bleeding(dicynone and bleeding aromatic acid), ascites, the level oftotal biliruhin, the average diameter of main portal vein, a variation of flow and pressure,PLT and so on, were studied by logistic regression and multivariat analysis. Meetingconditions of the85patients were randomly divided into three groups: group A(contain38patients),did not apply anticoagulant and thrombolytic drugs anticoagulation therapyafter operation; group B(contain25patients), received anticoagulation therapy afteroperation when platelet count was over300×10^9/L; group C(contain22patients),underwent anticoagulation therapy in the early postoperative stage, through the use ofthrombin inhibitors and a subcutaneous injection of the low molecular weight heparinonce a day to reduce blood coagulation status. Warfarin20mg orally, three times a day.Through the use of antiplatelet drugs reduce platelet aggregation, thereby, to reduce blood viscosity. Dipyridamole50mg orally, three times a day; Enteric-coated aspirin150mg orally, three times a day,Dextran500ml and Chuan Qiong hydrochloride160mgintravenous drug use, once a day. The treatment can usually choose from1-2, we usethe low molecular weight dextran and aspirin. The three groups of portal veinthrombosis were retrospectively analyzed.Results: Regression univariate analysis showed the indexs in patients withpreoperative portal vein thrombosis were not statistically significant(P>0.05).Compared non-thrombus group, random group and thrombus group,the portal diameter,the diameter of the splenic vein, splenic length, thickness of spleen, spleen size of thepatients, the inner diameter of indicators were no significant difference. Portal veinthrombosis of portal hypertension splenectomy porta-azygous devascularization wasrelated to the number of thrombocytes after operation, and the diameter and the bloodflow of portal vein were measured, The portal system thrombosis occurred in group A12patients(31％)，in group B6patients (24%) and in group C1(4．5％), The incidenceof portal system thrombosis was not significantly different between group A andB(P>0.05),but markedly different between group A and C (P<0．05) and betweengroup B and C(P<0.05).Conclusions: The relevant risk factors of portal vein thrombosis was related to thenumber of thrombocytes after operation, the high level of plasma D-dimer, the diameterand the blood flow of portal vein. The early diagnosis and anticoagulation therapy givenin the early stage can prevent the occurrence of the portal system thrombosis．...