Risk Factors Analysis And Risk Prediction Of Portal Vein Thrombosis After Splenectomy And Pericardial Devascularization

Objective:The perioperative indexes of 105 cases of splenectomy and pericardial devascularization were retrospectively collected to analyze the risk factors of postoperative portal vein thrombosis,establish relevant prediction models,and discuss the clinical significance of each risk factor,so as to provide guidance for the prevention and treatment of postoperative portal vein thrombosis.Methods:The perioperative clinical data of 105 cases of splenectomy and pericardial vasectomy performed in the Second Department of Hepatobiliary Surgery,the First Hospital of Jilin University from January 2018 to December 2020 were retrospectively analyzed,and the relevant data were divided into general data,preoperative data,surgical data and postoperative data.Excel2007 was used for sorting,SPSS22.0 software was used for statistical analysis,The measurement data are expressed by x±s,and counting data were expressed by frequency or rate.The T test was used to compare the two groups of measurement data,while the rank sum test was used to compare the two groups of measurement data.Counting data were compared by chi-square test.Multivariate analysis was performed by Logistic multivariate analysis.Binary Logistic stepwise regression was used to establish the prediction model,which entered into the standard model P<0.05,exclusion criteria P>0.10;The model regression effect was tested by likelihood ratio.The prediction effect of different indexes on the occurrence of postoperative portal vein thrombosis was analyzed by ROC curve analysis.P<0.05 was considered statistically significant.Results:The perioperative data of 105 patients were analyzed by univariate analysis,multivariate analysis and ROC prediction results were as follows:(1)Univariate analysis showed age(t=4.044,P<0.001),gender(χ~2=7.214,P=0.007),diabetes mellitus(χ~2=12.999,P<0.001),hyperlipidemia(χ~2=7.232,P=0.007),preoperative Child grade(χ~2=15.750,P<0.001),preoperative albumin(t=5.256,P<0.001),preoperative prothrombin time(t=2.259,P=0.027),AFP(Z=2.479,P=0.013),portal vein diameter(t=4.608,P<0.001),preopera-tive cholinesterase(Z=3.064,P=0.002),operative time(Z=4.874,P<0.001),intraoperative blood transfusion(χ~2=10.769,P=0.001),spleen weight(Z=2.240,P=0.025)and postoperative platelet(Z=2.653,P=0.008)had statistically significant effects on the occurrence of portal vein thrombosis.(2)Multivariate analysis was further performed,and the results showed that AFP and portal vein diameter were independent influencing factors for the occurrence of postoperative portal vein thrombosis.For AFP,the higher the AFP level before surgery,the higher the risk of postoperative portal vein thrombosis(OR:2.141,95%CI:1.098～4.175,P=0.013);For portal vein diameter,the greater the portal vein diameter,the higher the risk of postoperative portal vein thrombosis,OR:599.244,95%CI:11.644～30839.245,P<0.001.(3)Further analysis of the prediction effect of independent influencing factors on the occurrence of postoperative portal vein thrombosis showed that the preoperative AFP and AUC under the ROC curve were 0.643.When preoperative AFP≥5.36 was used to predict the occurrence of postoperative portal vein thrombosis,the sensitivity,specificity and Youden index were 42.86%,84.13%and 0.270respectively.For portal vein diameter,the AUC was 0.736.When portal vein diameter≥1.75cm was predicted as postoperative portal vein thrombosis,the sensitivity,specificity and Youden index of this prediction were 54.76%,90.48%and 0.452 respectively.4.The established regression model was further analyzed by ROC curve to evaluate the prediction effect of the model,and the analysis results showed that the AUC was 0.920.When the P value calculated by the model was greater than or equal to 0.614,the prediction sensitivity was76.19%,specificity was 96.38%,and Youden index was 0.730.Conclusion:(1)Age,gender,diabetes,hyperlipidemia,preoperative Child grade,preoperative albumin,preoperative prothrombin time,AFP,portal vein diameter,preoperative cholinesterase,operative time,intraoperative blood transfusion,spleen weight and postoperative platelet have influences on the occurrence of portal vein thrombosis.(2)Preoperative AFP and portal vein diameter were analyzed as independent factors affecting the occurrence of postoperative portal vein thrombosis.