The Analysis Of Risk Factors Of Portal Vein Thrombosis In Endoscopic Treatment Of Liver Cirrhosis And Portal Hypertension

Background:As one of the rare but serious complication of liver cirrhosis an d portal hypertension,portal vein thrombosis(PVT)is often found hiddenly a nd suddenly.Although the main clinical manifestation include high fever and ab dominal pain,lots of patients are found to be suffering from PVT without any antecedent symptoms.Therefore,PVT is difficult to be diagnosed early and usu ally made some adverse consequences when we found it through ultrasound or other imaging technology.Nowadays,with the continuous development of digest ive endoscopy technology,endoscopic injection sclerotherapy(EIS),endoscopic variceal ligation(EVL)and endoscopic variceal obturation(EVO)are recogni zed widely as treatments of esophageal/gastric varices on the basis of liver ci rrhosis and portal hypertension.However in the clinical application of endoscopi c treatment for esophageal/gastric varices,single endoscopic operation often ca nnot obtain satisfactory results.Therefore more than once combined application of EIS,EVO and EVL that called endoscopic sequential treatment are needed t o obtain the lowest incidence of bleeding.However,during endoscopic sequential therapy(EIS/EVL/EVO)for liver cirrhosis with hypertension(esophageal/gastric varices),there are a number of patients diagnosed with portal vein thrombosis in the perioperative period.Therefore,we usually need to medicate the patients who were at lower risk for bleeding clinically with regular anticoagulants or medication to improve microcirculation,and that always led to more difficult t reatment.In a word,it is important to diagnose PVT earlier and implement antic oagulation therapy in the process of endoscopic sequential treatment.Objective:Through the collection and analysis of risk factors of patients sufferi ng liver cirrhosis and portal hypertention before endoscopic treatment,we expec t to find preoperative predictors of PVT in the subsequent endoscopic therapy and provide some help in the screening of PVT high-risk patients and guidanc e for prophylactic anticoagulantion before endoscopic treatment.Methods:159 patients with liver cirrhosis and portal hypertension received in t he second Department of Gastroenterology of Shandong Provincial Hospital fr om Sep.2011 to Sep.2016 were analyzed retrospectively.Among them 48 cas es diagnosed with PVT in the preoperative period of endoscopic sequential tre atment were divided into PVT group,and the rest of the 111 cases without P VT were divided into the control group.Based on the clinical experience and thought,the patients' gender,age,splenectomy history,Child-Pugh score,way of endoscopic therapy,the amount of sclerosant/tissue glue,endoscopic sclerot herapy frequency,tumor history,platelet count and D-dimer level in peripheral blood were examined and analyzed selectively by single factor analysis and lo gistic regression model analysis.Results:Child-Pugh score and blood D-dimer level were significantly associated to PVT in endoscopic sequential treatment,the difference was statistically sig nificant(P<0.05).Beyond that,Splenectomy history was likely related to PVT(P=0.051?P=0.061).However,the patients' gender,age,way of endoscopic th erapy,the amount of sclerosant,endoscopic sclerotherapy frequency,tumor hist ory and platelet count were not associated with PVT,the difference was not st atistically significant(P>0.05).Conclusion:Child-Pugh score and D-dimer level in peripheral blood are the un ique independent risk factors of portal vein thrombosis in endoscopic sequentia 1 treatment for patients with liver cirrhosis and portal hypertension,and clinica lly we should pay more attention to these patients by applying regular anticoa gulants or medication to improve microcirculation for early detection and prev ention of PVT after endoscopic treatment.