To analyze the risk factors of portal vein system thrombosis (PVST) after splenectomy in patients with cirrhosis of liver and portal hypertension (PH).

The clinical data of 278 patients with cirrhosis and PH who underwent splenectomy in Shengjing Hospital Affiliated to China Medical University from November 2011 to December 2018 were retrospectively analyzed.

The formation rate of postoperative PVST was 38.8% (108/278). According to the Logistic regression-ROC curve model, operative time (AUC=0.651, 95% CI: 0.585-0.716), intraoperative plasma transfusion (AUC=0.615, 95% CI: 0.546-0.684), postoperative splenic vein diameter (AUC=0.665, 95% CI: 0.598-0.731) were independent risk factors for PVST formation after splenectomy. However, the intraoperative RBC transfusion (AUC=0.583, 95% CI: 0.514-0.651) and TT level on the 7 d after surgery(AUC=0.634, 95% CI: 0.568-0.699) were independent protective factors. All the above indexes had certain predictive effects on postoperative PVST formation, and the prediction efficiency of combining the above indexes was highe (AUC=0.783, 95% CI: 0.727-0.839).

For PH patients with liver cirrhosis, the operation time should be shortened as much as possible, and PVST may be prevented by appropriate transfusion of red blood cells and reduction of plasma transfusion during perioperative period. Combining the factors of splenic vein diameter and TT level on the 7th day is helpful to improve the prediction of PVST.