血小板重度减少肝细胞癌患者行肝脾联合切除术的可行性研究  

A feasibility study of combining hepatectomy with splenectomy in hepatocellular carcinoma patients with severe thrombocytopenia

作　　者：张宏伟 贾哲 赫嵘 张珂 蒋力 Zhang Hongwei;Jia Zhe;He Rong;Zhang Ke;Jiang Li(Department of General Surgery,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院普外科,北京100015

出　　处：《中华肝胆外科杂志》2022年第9期641-645,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨血小板重度减少(血小板计数≤30×10^(9)/L)肝细胞癌患者行肝脾联合切除的可行性。方法回顾分析首都医科大学附属北京地坛医院2016年1月至2021年1月收治的46例原发性肝细胞癌伴血小板减少患者资料,其中男性32例,女性14例,年龄(55.0±7.9)岁。根据术前1 d血小板水平分为观察组(20×10^(9)/L<血小板计数≤30×10^(9)/L,n=20)和对照组(30×10^(9)/L<血小板计数<100×10^(9)/L,n=26),均行肝脾联合切除或肝脾联合切除加贲门周围血管离断术。比较两组肝功能(天冬氨酸氨基转移酶、丙氨酸氨基转移酶、白蛋白等)、血小板计数、术后3 d内每日引流量、血红蛋白丢失量(术后当天血红蛋白与术前1 d血红蛋白差值)、住院时间等。复诊或电话随访再出血和门静脉系统血栓形成情况。结果两组术后2周肝功能指标比较,差异均无统计学意义(均P>0.05),均可恢复至正常水平。观察组术后第1天、第3天、第5天血小板计数均低于对照组,差异均有统计学意义(均P<0.05)。观察组和对照组血小板计数分别于术后第5天和第3天恢复至正常范围。对照组术后3 d内每日引流量为(407.3±124.2)ml、血红蛋白丢失量(31.1±8.6)g、住院时间(13.7±3.3)d,优于观察组的(647.5±209.5)ml、(38.3±12.8)g、(16.9±3.7)d,差异均有统计学意义(均P<0.05)。观察组3例(15.0%)发生食管胃底静脉破裂再出血,门静脉系统血栓形成10例(50.0%),对照组分别为2例(7.7%)、12例(46.2%),两组对比差异均无统计学意义(均P>0.05)。结论血小板重度减少并非是肝细胞癌患者肝脾联合切除的绝对禁忌证,经过充分合理的术前调整和评估,手术仍然安全可行。Objective To study the feasibility of combining hepatectomy with splenectomy in hepatocellular carcinoma patients with severe thrombocytopenia(platelet count≤30×10^(9)/L).Methods The data of 46 patients with primary hepatocellular carcinoma with thrombocytopenia treated at Beijing Ditan Hospital,Capital Medical University from January 2016 to January 2021 were analyzed retrospectively.There were 32 males and 14 females,aged(55.0±7.9)years.According to the platelet count one day before operation,the patients were divided into the study group(20×10^(9)/L<platelet count≤30×10^(9)/L,n=20)and the control group(30×10^(9)/L<platelet count<100×10^(9)/L,n=26).All patients underwent hepatectomy combined with splenectomy or hepatectomy combined with splenectomy and pericardial devascularization.The liver function(aspartate aminotransferase,alanine aminotransferase,albumin),platelet count,daily abdominal drainage within 3 days after operation,drop in hemoglobin(the difference between hemoglobin on the day after operation versus 1 day before operation)and hospital stay were compared between the two groups.Rebleeding and portal vein thrombosis were studied.Results There was no significant difference in liver function between the two groups 2 weeks after operation(all P>0.05).The platelet count on the 1st,3rd and 5th day after operation in the study group was significantly lower than that in the control group(all P<0.05).The platelet count in the study group and the control group returned to the normal range on the 5th and 3rd day after operation,respectively.The daily abdominal drainage volume,drop in hemoglobin and hospital stay in the control group were(407.3±124.2)ml,(31.1±8.6)g and(13.7±3.3)d,respectively,which were significantly better than those in the study group(647.5±209.5)ml,(38.3±12.8)g,(16.9±3.7)d.There were 3 patients(15.0%)who developed esophageal and gastric fundus vein rebleeding and 10 patients(50.0%)with portal vein thrombosis in the study group,versus 2 patients(7.7%)and 12 patients(46.2%)res

关 键 词：癌 肝细胞 血小板减少 高血压 门静脉 肝脾联合切除 

分 类 号：R735.7[医药卫生—肿瘤]