Clinical Manifestations And Treatment Options Of Cavernous Transformation Of Portal Vein

PurposeTo analyze the clinical manifestations of cavernous transformation of portal vein and explore the treatment.MethodRetrospective analysis the medical records of cavernous transformation of portal vein patients treated in the first affiliated Hospital of Zhengzhou University from January 2011 to January 2018,and follow up the recovery of these patients after treatment.The data of medical records include etiology,symptoms,results of laboratory and imaging examination,treatment methods,curative effect,complications and so on.All the medical records were collected and analyzed to summarize the general clinical features of cavernous transformation of portal vein.And then,according to the different treatment plans,the patients were divided into three groups: drug treatment group,interventional treatment group and surgical treatment group.The records before and after treatment in each group were analyzed to evaluate the therapeutic effect of that kind of treatment scheme;the difference among the three groups before and after treatment were analyzed separately to evaluate the differences between the three treatments.ResultA total of 47 patients,including 23 males and 24 females,were enrolled in this study,with an average age of 44.09±14.93 years.Of all the 47 patients,Abdominal pain was found in 30 cases(63.8%),gastrointestinal bleeding(hemesis,black stool)in 13 cases(28%),anorexia,nausea and vomiting in 8 cases(17%).The spleen thickness of 34 patients(75.6%)exceeded the normal value.33 patients(70.2%)had higher spleen diameters than normal.Anemia occurred in 19 patients(40.4%),PLT was lower than normal in 28 patients(59.6%),WBC was lower than normal in 18 patients(38.3%).Among all 47 patients,the 27 patients(57.45%)in the medical treatment group were mainly treated with anticoagulant,thrombolytic,anti-inflammatory and hepatoprotective drugs,the 11 patients(23.4%)in the surgical treatment group were treated with splenectomy,and the nine patients(19.1%)in the interventional therapy group were treated with embolization and thrombolysis(3cases),filter thrombectomy(1 case)or TIPS(5 cases).There was no significant difference in WBC,PLT,ALT,AST and TBIL between before and after treatment in the medical treatment group(P > 0.05).After treatment,the WBC increased(t=-2.91,P=0.01),PLT increased(t=-4.29,P=0.00),TBIL decreased(t=2.94,P=0.01),ALT decreased(t=2.69,P=0.02),AST decreased(t = 3.11,P = 0.01)in the surgical treatment group.While in the interventional therapy group,the PLT and AST went higher than before(P<0.05).During the treatment,one patient(3.7%)in the medicine treatment group had complications characterized by abdominal pain and fever,5patients(55.60%)in the interventional therapy group had complications of abdominal pain,abdominal distension and ascites,7 patients(63.60%)in the surgical treatment group had complications of ascites and fever.There was no significant difference in WBC,PLT,ALT,AST,TBIL,ALB,gender and age among the three groups(P > 0.05)before treatment.But when it goes after treatment,PLT and WBC in surgical treatment group were higher than those in drug treatment group(P<0.05),AST and ALT were lower than those in interventional treatment group and drug treatment group(P<0.05),TBIL was lower than that in drug treatment group(P<0.05).During the follow-up period,in the drug treatment group,2 patients had intermittent gastrointestinal symptoms such as anorexia,10 patients had gastrointestinal hemorrhage,and other patients did not complain of obvious discomfort.In the interventional therapy group,there were 1 patient with hepatic encephalopathy,1patient with anorexia,3 patients developed gastrointestinal hemorrhage and 1 patient died of cardiovascular disease.Except one patient died of pulmonary infection and 2patients suffered from gastrointestinal hemorrhage,all the other patients in surgical treatment group reported no obvious discomfort.ConclusionThe etiology of cavernous transformation of portal vein is complex,nearly half of all the patients is unknown.And among various the clinical manifestations,abdominal pain,abdominal distension,upper abdominal discomfort,spleen swelling and hypersplenism are the most common.As for the treatment of cavernous transformation of portal vein treatment,drug,interventional surgery and surgical surgery are all effective in improving and relieving symptoms.However,compared with simple drug therapy or interventional surgery,splenectomy has definite curative effect and less adverse prognosis reactions.For cavernous transformation of portal vein patients who meets the surgical indications,surgical treatment may be a better choice.