Combined Anatomic Splenectomy And Anticoagulant Therapy In Prevention Of Portal Vein Thrombosis After Splenectomy

Aims:Portal vein thrombosis (PVT) is a common complication following splenectomy in patients with liver cirrhosis and portal hypertension, which also brings difficulties to future possible liver transplantation. This paper retrospectively analyzes the preventive effect of combined anatomic splenectomy and early anticoagulant therapy on post-splenectomy portal vein thrombosis in patients with portal hypertension.Methods:We retrospectively analyzed 136 patients who underwent splenectomy at our hospital between January 2010 and December 2013 due to liver cirrhosis and portal hypertension. The patients are divided into three groups based on the types of splenectomy and the presence of early anticoagulation:group A consists of 46 patients,who underwent conventional splenectomy, and did not receive early postoperative anticoagulant therapy; group B contains 40 patients, who still underwent conventional splenectomy, but received early postoperative anticoagulant therapy; and group C consists of 50 patients, who underwent anatomic splenectomy, and received early postoperative anticoagulant therapy. Patient conditions, such as coagulation function, splenic and portal vein thrombosis, intra-abdominal hemorrhage, pancreatic leakage and intra-abdominal infections, are observed postoperatively.Results:Incidence of PVT is approximately 41.3%(19/46) in group A, and about 20.0%(8/40) in group B, showing a significant difference (p<0.05); while group C has a 4.0%(2/50) incidence of portal vein thrombosis, which is significantly different compared with both groups A and B (p<0.00 and 0.021, respectively). Despite the presence of liver cirrhosis and portal hypertension in patients, early postoperative anticoagulant therapy has no significant impact on coagulation function and intra-abdominal hemorrhage of these patients (p> 0.05). Anatomic splenectomy can reduce the occurrence of complications such as postoperative bleeding, pancreatic leakage and intra-abdominal infections (p<0.05).Conclusion:Combined anatomic splenectomy and early postoperative anticoagulant therapy can reduce post-splenectomy portal vein thrombosis in patients with portal hypertension, and is conducive to the future liver transplantation therapy may be needed by the patients.