Surgery · 2009
Diameter of splenic vein is a risk factor for portal or splenic vein thrombosis after laparoscopic splenectomy.
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Danno Katsuki, Ikeda Masataka, Sekimoto Mitsugu, Sugimoto Tomoyuki, Takemasa Ichiro, Yamamoto Hirofumi, Doki Yuichiro, Monden Morito, Mori Masaki
Аннотация
BACKGROUND: Splenomegaly is a risk factor for post-splenectomy portal or splenic vein thrombosis (PSVT) due to large splenic vein stump. The relationship between splenic vein diameter (SVD) and PSVT has not been established.
OBJECTIVES: To investigate whether SVD is a risk factor for PSVT.
METHODS: Forty patients who underwent laparoscopic splenectomy were analyzed. Preoperative and postoperative enhanced helical computed tomographic scans were obtained in all patients, and subsequent follow-up was performed in patients with PSVT during anticoagulant therapy. SVDs at the junction of portal vein (PV) 2, 4, and 6 cm from the junction of PV were measured preoperatively and postoperatively. Multivariate analysis was performed using logistic regression model.
RESULTS: PSVT was diagnosed in 52.5% (21/40) patients. Preoperative SVD was significantly larger in patients with PSVT than in those without PSVT. Seventy-two percent of patients (16/22) with PSVT in splenic veins with a diameter of >8 mm developed PSVT. Multivariate analysis identified preoperative SVD as a significant and independent determinant of PSVT. At a cutoff value of 8 mm, receiver operator characteristic analysis for prediction of PSVT provided an area under the curve of 0.8552 (95% CI 0.821-1.000).
CONCLUSION: Preoperative SVD is a risk factor for post-splenectomy PSVT. We recommend measurement of SVD preoperatively in patients elected to undergo splenectomy, and a close follow-up of patients with SVD greater than 8 mm.
OBJECTIVES: To investigate whether SVD is a risk factor for PSVT.
METHODS: Forty patients who underwent laparoscopic splenectomy were analyzed. Preoperative and postoperative enhanced helical computed tomographic scans were obtained in all patients, and subsequent follow-up was performed in patients with PSVT during anticoagulant therapy. SVDs at the junction of portal vein (PV) 2, 4, and 6 cm from the junction of PV were measured preoperatively and postoperatively. Multivariate analysis was performed using logistic regression model.
RESULTS: PSVT was diagnosed in 52.5% (21/40) patients. Preoperative SVD was significantly larger in patients with PSVT than in those without PSVT. Seventy-two percent of patients (16/22) with PSVT in splenic veins with a diameter of >8 mm developed PSVT. Multivariate analysis identified preoperative SVD as a significant and independent determinant of PSVT. At a cutoff value of 8 mm, receiver operator characteristic analysis for prediction of PSVT provided an area under the curve of 0.8552 (95% CI 0.821-1.000).
CONCLUSION: Preoperative SVD is a risk factor for post-splenectomy PSVT. We recommend measurement of SVD preoperatively in patients elected to undergo splenectomy, and a close follow-up of patients with SVD greater than 8 mm.