肝硬化门静脉高压性外周血细胞减少对手术预后的影响

Effect of peripheral cytopenias due to cirrhotic portal hypertension on postoperative prognosis

目的探讨外周血细胞减少对手术预后的影晌,并从外周血细胞减少的角度提出治疗策略。方法回顾性分析1991年1月至2011年6月海南省人民医院普通外科收治的366例肝炎后肝硬化门静脉高压性脾肿大患者的临床资料。结果三种血细胞计数均正常者36例(9.8%),并发一种以上外周血细胞减少者330例,其中单种血细胞减少占30.0%(99/330),两种血细胞减少占35.8%(118/330),三种血细胞均减少占34.2%(113/330)。全组均行脾脏切除+门奇断流术或分流术。血细胞正常组与血细胞减少组手术预后比较差异有统计学意义(P<0.05)。单种血细胞减少与多种血细胞减少的手术预后比较差异也有统计学意义(P<0.05)。在白细胞(WBC)、红细胞(RBC)和血小板(PLT)减少的三个因素中,仅PLT减少对手术预后有明显影响,差异有统计学意义(P<0.05)。结论外周血细胞减少对手术预后有一定影响,单种血细胞减少的手术预后明显优于多种血细胞减少,血细胞减少越多越重、预后越差,PLT减少是影响手术预后的主要因素,重度PLT减少应切除肿大的脾脏。

Objective To investigate the effect of peripheral cytopenias on the operative prognosis in patients with cirrhotic portal hypertension, so as to put forward the treatment strategies from the perspective of peripheral cytopenias. Methods A retrospective analysis was performed on the clinical data of 366 patients with splenomegaly of posthepatitic cirrhotic portal hypertension in Department of General Surgery, People＇s Hospital of Hainan Province from January 1991 to June 2011. All data were processed with SPSS19.0, and the χ2test was used for univariate analysis. Comparisons between thrombocytopenia, leucopenia, and erythropenia were conducted by multiple linear regression analysis. Results Thirty-six patients（9.8%） had a normal blood cell count and 330 patients had peripheral cytopenias, in which mono-lineage cytopenias accounted for 30.0%（99/330）, bi-lineage cytopenias accounted for35.8%（118/330）, and tri-lineage cytopenias accounted for 34.2%（113/330）. There were significant statistical differences in the postoperative prognosis between the normal blood and the cytopenias（P〈0.05）, as well as between mono-lineage cytopenias and multi-linage cytopenias（P〈0.05）. In comparison, among leucopenia, erythropenia and thrombocytopenia, only thrombocytopenia showed a significant influence on the postoperative prognosis（P〈0.05）.Conclusion Peripheral cytopenias can exert definite influences on postoperative prognosis. Patients with mono-lineage cytopenias have significantly better surgical outcomes than those with multi-lineage cytopenias. The more severe the cytopenias, the poorer the surgical outcome. Thrombocytopenia is the major influencing factor of surgical outcome, and splenectomy could be an effective treatment for splenomegaly associated with severe thrombocytopenia.