摘要
目的探讨肝细胞癌患者行肝部分切除术后早期血小板计数与术后肝功能衰竭的相关性。方法回顾性分析2013年7月至2015年8月于南京鼓楼医院行肝部分切除术的71例病理诊断为肝细胞癌患者的临床资料。根据术后2h内血小板计数（plateletcount，PLT），将患者分为低血小板计数（PLT〈100×10^9/L）组（n=24，33．8％）和正常血小板计数（PLT≥100×10^9／L）组（n=47，66．2％）。分析患者术后早期血小板计数与血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆红素（TBil）、直接胆红素（DBil）以及术后肝功能衰竭发生率的关系。结果71例患者中25例（35．2％）患者术后出现Ⅰ-Ⅲ级并发症。其中8例（11．3％）出现A级肝功能衰竭，但无再次手术及死亡病例。两组总体并发症发生率差异无统计学意义。但与正常血小板计数组比较，术后早期低血小板计数组发生A级肝功能衰竭比例（29．2％比2．1％，χ^2=11．618，P〈0．05）以及ALT、AST、TBil等峰值[（462．5±135．7）U／L比（307．9±192．6）U／L，（440．0±163．3）U／L比（265．8±155．8）U／L，（29．5±9．1）μmol／L比（17．9±8．8）μmol／L，t=3．507、4．385、5．129，P〈0．05]明显增高，且术后肝功能恢复至正常水平所需时间更长。Logistic多因素回归分析显示术后早期低血小板计数是肝细胞癌肝部分切除术后肝功能衰竭的独立危险因素。结论血小板与肝细胞癌肝部分切除术后肝脏再生有关。术后早期低血小板计数患者出现肝功能衰竭风险增加，肝功能恢复延迟。
Objective To investigate the correlation between immediate postoperative platelet count with liver failure after partial hepatectomy in patients with hepatoeellular carcinoma. Methods The clinical data of 71 patients with hepatocellular carcinoma who underwent liver resection at the Hepatopancreatobiliary Surgery Department of Nanjing Drum Tower Hospital from July 2013 to August 2015 were retrospectively analyzed. The clinical diagnosis was confirmed by pathology of the resected specimens. Based on postoperative platelet count within 2 h, the patients were divided into the low platelet count （PLT 〈 100 ×10^9/L） group （ n = 24, 33.8% ） and the normal platelet count （ PLT/〉 100×10^9/L） group （ n = 47, 66.2% ）. The correlations between immediate postoperative platelet count with serum indexes including serum alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, total bilirubin （TBil） and direct bilirubin （DBil） were analyzed, and the incidences of posthepatectomy liver failure was also evaluated in these two groups. Results There was no re-operation and perioperative death in this study. Among the 71 patients, 25 patients （35.2%） developed postoperative complications （ grade Ⅰ to Ⅲ ）, and 8 patients （ 11.3% ） suffered from postoperative liver failure （ grade A ）. When compared with the normal platelet count group, the low platelet count group had significantly increased risks of postoperative liver failure （29.2% vs 2.1%, χ^2 = 11. 618, P 〈 0.05）, increased postoperative peaks of ALT, AST, TBil and DBil levels [（462.5 ±135.7）U/L vs （307.9 ± 192.6） U/L, （440.0 ± 163.3） U/L vs （265.8 ± 155.8） U/L, （29.5 ± 9. 1 ） μmol/L vs （ 17.9 ± 8.8） μmol/L, t = 3. 507, 4. 385, 5. 129, P 〈 0.05, respectively] and longer normalization time of liver function. Multiple Logisfie regression analyses revealed that an immediate postopera-tive low platelet count was an independent risk factor of posthepatectomy liver failure. Conclusions The platelet count was associated with the incidence of postoperative liver failure after partial liver resection in patients with hepatocellular carcinoma. Patients with an immediate postoperative low platelet count suffered from a high incidence of posthepatectomy liver failure and delayed liver function recovery.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2016年第5期294-298,共5页
Chinese Journal of Hepatobiliary Surgery
基金
江苏省卫生厅医学重点人才项目（RC2011003）
关键词
肝细胞癌
肝切除术
血小板计数
肝再生
Hepatocellular carcinoma
Liver resection
Platelet count
Liver regeneration
作者简介
通信作者：仇毓东，电子信箱：yudongqiu510@163．com
