肝癌肝移植患者围手术期凝血功能变化的癌栓分组研究

Changes of Coagulation Function during Peri-Operative Periodin Locally Advanced Liver Cancer Patients

目的在局部晚期肝癌肝移植患者中,观察癌栓患者和无癌栓患者围手术期凝血功能的变化。方法回顾性分析中山大学肿瘤防治中心2003年9月至2007年1月行肝移植的局部晚期肝癌患者31例。根据有无癌栓分为两组,比较两组患者移植前、术中无肝期、术后3d内的血小板(platelet,PLT)计数、血浆凝血酶原时间(prothrombintime,PT)、活化部分凝血酶原时间(activatedpartialthromboplastintime,APTT)、血浆纤维蛋白原(fibrinogen,Fib)和血浆凝血酶时间(thrombintime,TT)等凝血指标的测定结果,分析凝血功能的变化。结果与术前相比,两组患者PT、APTT和TT升高以及Fib和PLT降低以无肝期最为显著(P<0.01),术后患者延长的PT、APTT、TT和升高INR逐渐回落,降低的Fib和PLT恢复较慢。组间比较,术前癌栓组患者Fib和PLT低于无癌栓组(P<0.05)。术中无肝期及术后第1天,癌栓组患者PT、APTT和TT升高以及Fib和PLT降低程度都高于无癌栓组患者,围手术期癌栓组凝血物质的使用量多于无癌栓组。结论癌栓患者和无癌栓患者肝移植围手术期凝血功能变化趋势大致相同;癌栓患者围手术期低凝的因素较多,低凝状态在术中及术后1～2d表现更为突出,此类患者对凝血物质的需求较大,要注意补给。

Objective To analyze the changes of blood coagulation function in liver cancer patients during peri-operative period. Method Thirty-one locally advanced liver cancer patients receiving liver transplantation, between Sep.2003 to Jan.2007, were retrospectively analyzed. The patients were divided into two groups based on the presence or absence of tumor thrombosis. Several parameters were analyzed before, during （anhepatic phase）, and 3 days after the operation. These included the number of platelet （PLT）, prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （Fib） and thrombin time （TT）. Result Compared with the values recorded before transplantation, the PT, APTT, TT and INR were elevated, while Fib time and PLT were lowered （P 〈 0.01 ） during the anhepatic and post-operative period. The changes were most significant during the anhepatic phase. Prolonged PT, APTT and TT were recovered gradually, while the values of PLT and Fib time were slowly restored. Compared with the tumour non-throbosis group, the levels of PLT and Fib in tumor thrombus group were lower than those in the non-tumor thrombosis group before the operation （P 〈 0.05）. During the transplantation and the first day after transplantation, the elevation of PT, APTT and TT in the tumour thrombosis group was greater than the non-thrombosis group. The level of Fib and PLT in the tumour thrombosis group was lower than the non-thrombosis group. Conclusion The changes of coagulation functions during liver transplantation between the two groups were similar during the peri-operative period. Blood coagulation functions in the patients with tumor thrombosis are lower than the non-thrombosis patients, and these patients may need to have more coagulation substances.