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Analysis of Clinical Relevance and Risk Factors of Severe Acute Pancreatitis Accompanied with Portal Venous System Thrombosis

Author: ZhouJing
Tutor: LiWeiQin
School: Nanjing University
Course: Clinical
Keywords: Severe Acute Pancreatitis Pancreatic portal vein thrombosis Pancreatic portal hypertension Infection Complication Coagulation AT-Ⅲ D-D
CLC: R576
Type: Master's thesis
Year: 2013
Downloads: 60
Quote: 0
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Abstract


Portal venous system thrombosis (PVST) involving the splenic, mesenteric, and/or portal veins is a rare clinical syndrome of severe acute pancreatitis (SAP) and can lead to gastric and esophageal varices called pancreatic portal hypertension(PPH). Pancreas located in the hub of the portal system. Splenic vein is adjoined to pancreas according to the anatomy and is wrapped by peripancreatic connective tissue. So, varies kinds of pancreatic disease could lead to narrow, thickening and embolism portal veins. This results in venous hypertension in collateral pathways, producing gastric varices. In the past studies, three main cause of PVST is pancreatic tumor (39%), chronic pancreatitis (32.6%), pancreatic pseudocyst(19.4).With the development of recognition and inspection techniques, more and more SAP patients were diagnosed with PVST and/or PPH. However, little is known about incidence, clinical relevance, risk factor and optimal treatment strategy. This study is mainly about the clinical characters, risk factors and prognosis of patients gained SAP accompanied with PVT.PARTI The Clinical relevance of severe acute pancreatitis accompanied with portal venous system thrombosisObjective:The aim of the study was to evaluate the clinical relevance of patients suffered SAP accompanied with PVST.Methods:164patients admitted among January,2012to December,2012were reviewed. Contrast-enhanced CT scan and portal venous system imaging was conducted during their first72h after admitted to the hospital. Clinical and laboratory data were collected in the first3days.Results:The mean days from SAP onset to thrombosis diagnosis is38.77±33.51days.56patients were diagnosed with PPVT:11(6.7%) cases of PV thrombosis,22(13.4) cases of SV thrombosis,3(1.8%) cases of SMV thrombosis.10(6.1%) cases of PV+SV thrombosis.4(2.4%) cases of PV+SMV thrombosis.2(1.2%) cases of SV+SMV thrombosis.4(2.4%) cases of PV+SV+SMV thrombosis.Among56SAP patients with PPVT,26patients diagnosed with PPH:5(8.9%) cases of PVT with gastric varices.6(10.7%) cases of SVT with gastric varices. None case of SMVT with gastric varices.8(14.3%) cases of PVT+SVT with gastric varices.3(5.4%) cases of PVT+SMVT with gastric varices.1(1.8%) case of SVT+SMVT with gastric varices.2(3.6%) case of PVT+SVT+SMVT with gastric varices.1case case of PVT+SVT+SMVT with esophageal and gastric varices.Among56SAP patients with PPVT,23patients diagnosed with ascites:5(8.9%) cases of PVT with ascites.4(7.1%) cases of SVT with ascites. None case of SMVT with ascites.7(12.5%) cases of PVT+SVT with ascites.3(5.4%) cases of PVT+SMVT with ascites.2(3.6%) case of SVT+SMVT with ascites.4(7.1%) case of PVT+SVT+SMVT with ascites.Compare SAP with PPVT group and none-PPVT group, the APACHEII score is15.4±5.6vs.11.4±3.4;p=0.01.The Ranson score is4.7±0.8vs.3.9±0.9;p=0.01.The Balthazar CT score is7.8±2.2vs.6.1±1.1; p=0.04.Death cases is17vs.8(30.4%vs.7.4%); p<0.001.The number of patients need surgery or drainage is46vs.55(82.1%vs.50.9%); p=0.12.The number of patients with MODS is48vs.36(85.7%vs.33.3%); p=0.02。The number of patients with pancreatic necrosis is42vs.35(75%vs.32.4%); p=0.03.The number of patients with positive blood samples is36vs.24(64.3%vs.22.2%); p=0.02。 The mean hospital days is43.2±35.3vs.21.9±13.8;p <0.001,mean ICU days is20.7±14.4vs.10.4±4.1;p<0.001.The number of patients with ascites is23vs.11(41.1%vs.10.2%);p=0.007.Duration of ascites is5±2.3vs.2.1±0.9;p=0.004.The amount of ascites is2400±1453vs.700±374;p=0.002.The intra-abdominal pressure is17.0±4.6vs.14.6±3.2;p=0.05。 Besides,5enteral nutrition intolerance cases happened in first3days.Conclusions:PPVT incidence reaches34.1%in SAP patients.46.4%of the PPVT patients finally developed PPH. Compared with the non-PPVT group, the PPVT group have higher APACHE II score, Ranson score, Balthazar CT score, death rate, hospital stay, ICU stay, ascites amount, ascites duration.PART2Risk factors of severe acute pancreatitis accompanied with pancreatic portal venous thrombosisObjective:The aim of this study is to analyze risk factors of severe acute pancreatitis accompanied with pancreatic portal venous thrombosis by using multivariate logistic regression analysis.Methods:164patients admitted among January,2012to December,2012were reviewed. Contrast-enhanced CT scan and portal venous system imaging was conducted during their first72h after admitted to the hospital. Patients’general characteristics,coagulation parameters, cholesterol level, triglycerides level,CRP level,HCT level, ANC cases data were collected in the first3days. Risk factors were analyzed by using multivariate logistic regression analysis.Results:PPVT was more common in males, and the ratio is nearly2:1.The mean age of PPVT group is49±15.73y while the non-PPVT group is45±12.75y, p=0.04.Smokers, drinkers, high cholesterol, hypertriglyceridemia and coagulability (such as D-D,PT,INR,AT-Ⅲ) are not the risk factors of thrombosis. Compare SAP with PPVT group and none-PPVT group, the HCT is0.292±0.065vs.0.337±0.083; p=0.001.The ANC cases is48(86%)vs.36(23.7%), p<0.001。 Conduct multivariate logistic regression with gender, age, HCT and ANC, PPVT incidence is correlate with Gender (OR:1.255(95%CI:0.081-0.802), p=0.02))、 HCT(OR:0(95%CI:0-0.007), p<0.001) ANC (OR:2.254(95%CI:0.42-03.774,p=0.04)Conclusions:Coagulation disorders are not the risk factor of PPVT. Gender and local factors caused by ANC are the risk factors of thrombosis.

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CLC: > Medicine, health > Internal Medicine > Digestive and abdominal diseases > Pancreatic diseases
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