Discussion on diagnosis and treatment in portal vein thrombosis after splenectomy

Abstract

Abstract: Objective To investigate the clinical characteristics of PVT in order to find out effective approaches on its diagnosis and treatment. Methods The clinical data of 135 consecutive patients with non-neoplastic liver cirrhosis who had undergone splenectomy from January 2010 to January 2013 in our institution were collected. Clinical and surgical characteristics of the patients who developed PVT postoperatively and those who did not develop PVT were compared. Results 135 patients after splenectomy in 16 cases (11.85%) occurred in PVT, all patients were confirmed by color Doppler ultrasound or contrast-enhanced CT examination. The comparison of preoperative, postoperative width of portal vein(1.53±0.19) cm vs (0.91±0.19) cm, splenic vein diameter (1.36±0.27) cm vs (0.75±0.19) cm, portal vein blood flow velocity (10.33±1.98) cm/s vs (13.65±2.31) cm/s were thrombus group than in non portal thrombosis group had significant difference. In 15 cases with thrombus dissolving anticoagulant therapy in whole or in part, of which 5 cases underwent percutaneous portal vein puncture and catheterization thrombolysis, followed up for 1 years without recurrence. Conclusion Preoperative portal vein diameter and blood flow velocity in predicting postoperative portal vein thrombosis has the function of guidance. Once PVT is diagnosed, timely anticoagulation therapy, interventional therapy should be considered as a good choice.

Key words: portal vein thrombosis, splenectomy, treatment

CLC Number:

ZHANG Aimin, ZHANG Tao, LI Riheng, YANG Jihong, CHEN Zhi. Discussion on diagnosis and treatment in portal vein thrombosis after splenectomy[J]. Medical Reserch and Education, 2014, 31(6): 16-20.

References

[1] MANGIA A, VILLANI M R, CAPPUCCI G, et al. Causes of portal venous thrombosis in cirrhotic patients: the role of genetic and acquired factors[J]. Eur J Gastroenterol Hepatol, 2005, 17(7): 745-751.
[2] VECCHIO R, CACCIOLA E, CACCIOLA R R, et al. Portal vein thrombosis after laparoscopic and open splenectomy[J]. J Laparoendosc Adv Surg Tech A, 2011, 21(1): 71-75.
[3] KUMAR A, SHARMR P, ARORA A. Review article: portal vein obstruction-epidemiology, pathogenesis, natural history, prognosis and treatment[J]. Aliment Pharmacol Ther, 2014, DOI: 10.1111/apt.13019.
[4] CAI M, ZHU K, HUANG W, et al. Portal vein thrombosis after partial splenic embolization in liver cirrhosis: efficacy of anticoagulation and long-term follow-up[J]. J Vasc Interv Radiol, 2013, 24(12): 1808-1816.
[5] ZHOU L, RUI J A, WANG S B, CHEN S G, QU Q. Risk factors of microvascular invasion, portal vein tumor thrombosis and poor post-resectional survival in HBV-related hepatocellular carcinoma[J]. Hepatogastroenterology, 2014, 61(134): 1696-1703.
[6] LLADó L, FABREGAT J, CASTELLOTE J, et al. Management of portal vein thrombosis in liver transplantation: influence on morbidity and mortality[J]. Clin Transplant, 2007, 21(6): 716-721.
[7] LI M X, ZHANG X F, LIU Z W, LV Y. Risk factors and clinical characteristics of portal vein thrombosis after splenectomy in patients with liver cirrhosis[J]. Hepatobiliary Pancreat Dis Int, 2013, 12(5): 512-519.
[8] KIM H S, PATRA A, KHAN J, et al. Transhepatic catheter-directed thrombectomy and thrombolysis of acute superior mesenteric venous thrombosis[J]. J Vasc Interv Radiol, 2005, 16(12): 1685-1691.
[9] ROSEN M P, SHEIMAN R. Transhepatic mechanical thrombectomy followed by infusion of TPA into the superior mesenteric artery to treat acute mesenteric vein thrombosis[J]. J Vasc Interv Radiol, 2000,11(2): 195-198.
[10] LOPERA J E, CORREA G, BRAZZINI A, et al. Percutaneous transhepatic treatment of symptomatic mesenteric venous thrombosis[J]. J Vasc Surg, 2002, 36(5): 1058-1061.
[11] ZHOU W, CHOI L, LIN P H, et al. Percutaneous transhepatic thrombectomy and pharmacologic thrombolysis of mesenteric venous thrombosis[J]. Vascular, 2007, 15(1): 41-45.

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