肝豆状核变性肝硬化脾切除术后血小板变化趋势及其影响因素分析  

The platelet changes after splenectomy in patients with hepatolenticular degeneration cirrhosis and portal hypertension combined with splenomegaly and hypersplenism and its influencing factors

作　　者：鲁长文[1] 帅剑锋[1] 汪晓明[1] LU Chang-wen;SHUAI Jian-feng;WANG Xiao-ming(The First Hospital of Anhui Chinese Medicial University,Hefei 230032,China)

机构地区：[1]安徽中医药大学第一附属医院,合肥230032

出　　处：《肝胆外科杂志》2022年第3期194-198,共5页Journal of Hepatobiliary Surgery

摘　　要：目的 分析肝豆状核变性肝硬化门静脉高压合并脾大脾功能亢进患者脾切除术后血小板变化情况及其影响因素。方法 回顾性分析2017年12月-2020年9月因肝豆肝硬化门静脉高压行脾切除治疗患者的临床资料,记录其术前血常规、肝功能、凝血功能和术后第1、7天和峰值的血小板计数,以及手术时间、术中出血量。比较血小板术前术后的变化,并通过线性回归探索影响术后血小板峰值的因素。结果 54例患者术前血小板计数分别和术后第1、7天和峰值比较,差异均具有统计学意义(P<0.05);达到峰值的时间集中在术后第12~14天;相关分析指出年龄、术前红细胞、白蛋白和血清总胆红素与术后血小板峰值的相关具有统计学意义(P<0.05),多元线性回归分析得到校正的回归方程为:术后血小板峰值=2.500×术前血小板+2.140×白蛋白-4.698×年龄-4.625×血清总胆红素,残差的方差分析F=5.349,P=0.001。结论 对于HLD肝硬化门静脉高压合并脾大脾功能亢进的患者,肝功能越好、年龄越小,术后血小板升高幅度越高,应予以重视,及时检测并应用抗血小板药物,减少门静脉血栓形成。Objective To analyze the platelet changes after splenectomy in patients with hepatolenticular degeneration cirrhosis and portal hypertension combined with splenomegaly and hypersplenism and its influencing factors. Methods The clinical data of splenectomy in patients with portal hypertension due to hepatolenal cirrhosis from December 2017 to September 2020 were retrospectively analyzed. Preoperative blood routine, liver function, coagulation function, platelet count at first, seventh days and peak days, and operative time and intraoperative blood loss were recorded. The changes of platelet before and after operation were compared, and the factors influencing platelet peak after operation were explored through linear regression. Results The platelet counts of 54 patients were significantly different from those of first, seventh days after operation(P<0.05). The peak time was concentrated on the 12-14 day after operation. Correlation analysis showed that age, preoperative erythrocyte, albumin and serum total bilirubin were significantly correlated with platelet peak value after operation(P<0.05), and the regression equation corrected by multiple linear regression analysis was as follows: peak postoperative platelet count=2.500×Preoperative platelets+2.140×Albumin-4.698×Age-4.625×Serum total bilirubin. Variance analysis of residuals F=5.349, P=0.001. Conclusions For patients with HLD cirrhosis with portal hypertension and splenomegaly and hypersplenism, the better the liver function and the younger the age, the higher the range of platelet rises after surgery. We should pay attention to it, and detect and apply antiplatelet drugs in time to reduce portal vein thrombosis.

关 键 词：肝豆状核变性 门静脉高压 脾功能亢进 脾切除 血小板 

分 类 号：R658[医药卫生—外科学]