Abstract: Objective To analyze the risk factors of portal vein thrombosis (PVT) after laparoscopic splenectomy (LS) for hepatic portal hypertension (CPH) and hypersplenism (HS), and to provide reference for the prevention and treatment of perioperative PVT. Methods A total of 69 CPH patients with HS treated with LS were selected from People's Hospital of Hai’an from January 2020 to December 2023. According to whether LS-PVT occurred in imaging examination in one week after surgery, they were divided into LS-PVT group (n=18) and non-LS-PVT group (n=51). Baseline data, serological and imaging indicators were collected. Univariate and Logistic multivariate analysis were conducted to analyze the risk factors and independent influencing factors of LS-PVT in CPH patients combined with HS, and the predictive value of each independent influencing factor was analyzed by receiver operating curve (ROC) method. Results Among 69 patients with CPH combined with HS, 18 cases of LS-PVT occurred within 1 week after surgery, with an incidence rate of 26.09%. History of diabetes mellitus, history of upper gastrointestinal bleeding, preoperative fibrinogen (FBI), preoperative portal vein diameter (PVD), preoperative spleen length diameter (SL), intraoperative blood loss, intraoperative blood transfusion volume, platelet elevation rate (PPER3) in 3 days post-operation, and D-dimer (D-D) level in LS-PVT group were 44.44%, 22.22%, 3. 49 g/L, 18.24±1.86 mm, 19.06±1.95 mm, 376.49±45.37 mL, 254.56±28.41 mL, 1.47%, 2.03 mg/L, respectively. All of them were higher than those of 19.61%, 7.84%, 3.14 g/L, 15.47±1.69 mm, 15.83±1.82 mm, 321.76±41.05 mL, 216.90±24.52 mL, 1.18%, 0.84 mg/L in the non-LS-PVT group. The differences were statistically significant (t/χ²=4.836, 4.259, 4.576, 7.465, 7.263, 5.034, 5.628, 8.476, 9.158, all P<0.05). Logistics regression analysis shows that Increased levels of PVD and SL before surgery and PPER3 and D-D after surgery were independent influencing factors for the occurrence of LS-PVT in CPH patients with HS (95%CI: 0.754 ~ 1.705, 0.713 ~ 1.627, 0.860 ~ 1.842, 0.917 ~ 1.863; OR=1.162, 1.048, 1.256, 1.379, all P<0.05). ROC analysis showed that the areas under the curve (AUC) of preoperative PVD, SL and postoperative PPER3 and D-D levels were 0.773, 0.695, 0.845 and 0.758, respectively, with sensitivities of 72.22%, 77.78%, 88.89% and 83.33%. The specificities were 83.33%, 66.67%, 72.22%, and 66.67% (all P<0.01). Conclusion The increased levels of PVD and SL before surgery and PPER3 and D-D after surgery are independent influencing factors for the occurrence of LS-PVT in CPH patients with HS, and can be used as a reference for the prevention, evaluation and intervention of PVT in the perioperative period of LS.

Key words: Hepatic portal hypertension, Hypersplenism, Portal vein thrombosis, Risk factors, Perioperative management