Study On Relationship Between Portal Vein Thrombosis And Coagulation Function In Patients With Liver Cirrhosis After Splenectomy

Background:Patients with liver cirrhosis and portal hypertension after splenectomy are prone to form portal vein thrombosis (PVT), which is very serious complication after surgery. The formation of PVT further leads to the reduce of blood supply to the liver and increase portal vein pressure, and may also leads to upper gastrointestinal bleeding. If PVT was not detected and treated timely, serious consequences such as liver function damage may occur.At present, the pathogenesis of PVT in patients with liver cirrhosis and portal hypertension after splenectomy is not clear. Although there is relatively more study on unilateral factors analysis of PVT formation, study on multivariate analysis is still insufficiency. In this study, we analyzed changes of coagulation function indexes, diameter of portal vein, velocity of portal vein blood flow, platelet rate before and after splenectomy, which aimed to explore relationship between portal vein thrombosis and coagulation function in patients with liver cirrhosis after splenectomy and to provide theoretical basis for the early prevention and diagnosis of PVT.Aim:To analyze the relationship between PVT, coagulation function, diameter of portal vein, velocity of portal vein blood flow, platelet rate before and after splenectomy and provide theoretical basis for the early prevention and diagnosis of PVT.Method:From January,2014 to January,2016,100 patients with liver cirrhosis after splenectomy were selected. Patients were divided into two groups, thrombosis group and non thrombosis group according to the presence of PVT performed by color Doppler ultrasonography. Data related formation of PVT were collected, such as sex, age, diameter of portal vein, velocity of portal vein blood flow and child Pugh grading. Data related preoperative and postoperative indexes of coagulation function were collected, such as platelet count, activated partial thromboplastin time (APTT), thrombin time (PT), thrombin time (TT), plasma D-poly (DD) and fibrin original quantitative (FIB) to analysis relationship between the changes of the above indicators.Results:1. PVT occurrence in patients with liver cirrhosis and portal hypertension after splenectomy:100 patients were confirmed absence of portal vein thrombosis among preoperative examination, and 35 patients had portal venous system thrombosis through color Doppler ultrasound after surgery, and occurrence rate of PVT was 35.0%. Thrombosis normally formed 3.07±1.23 day after operation, and mainly distribute in the main portal vein and splenic vein.2. There was no correlation between the formation of PVT and patients’sex and age. However, significant correlation were observed between formation of PVT and inner diameter of portal vein, velocity of portal vein blood flow and platelet rate before and after splenectomy. Compared with the control group, portal vein blood flow rate after operation was significantly lower than that of the control group, and gradient of blood flow velocity was greater than that of the control group (p<0.05); the diameter of the portal vein was larger than that of the control group before and after operation(p< 0.05). The higher the rate of platelet (PLT) before and after surgery, the higher the incidence of thrombosis (p<0.05).3. There is no correlation between the occurrence of PVT and Child-Pugh grading in patients with liver cirrhosis after splenectomy.4. Compared with the control group, the DD value of the first day after surgery was higher than that in the control group (p<0.05); The DD value reached the highest peak at third days after operation in the thrombosis group.Conclusion:It is conducive for the early diagnosis and prevention of PVT by detecting the diameter of portal vein, portal vein blood flow velocity, blood platelet (PLT) and the ratio of D dimer (DD) in patients with liver cirrhosis after splenectomy, which has important clinical significance. By improving the coagulation function before surgery or early anti coagulation therapy to reduce incidence of PVT. After discharge, PVT is still likely to occur in the patients, it’s also needed to follow-up.