原发性肝癌切除后患者血小板计数的恢复情况及临床意义

Recovery of platelet count after hepatectomy for primary liver cancer and its clinical significance

目的:探讨原发性肝癌切除后患者血小板计数(PLT)的恢复情况及临床意义。方法:回顾性分析352例接受肝癌切除术的原发性肝癌(PLC)患者的临床资料,根据术后1d PLT水平,分为低PLT组(<100×109/L)和正常PLT组(100~300×109/L),并分析不同PLT水平与肝功能恢复、肝衰竭发生的关系。结果:352例PLC患者中,术后1d低PLT患者98例(27.84%),正常PLT患者254例(72.16%)。低PLT组术后1d、3d、5d、7d ALT和AST水平均高于正常PLT组,术后1d、3d、5d TBil高于正常PLT组,差异均有统计学意义(P<0.05)。术后肝衰竭组年龄高于无肝衰竭组,术后1d PLT<100×109/L、术前肝功能Child-Pugh B级的几率高于无肝衰竭组,差异有统计学意义(P<0.05)。多因素Logisitic回归分析显示,术后1d PLT<100×109/L、术前肝功能ChildPugh B级是肝切除术后并发肝衰竭的独立危险因素。结论:肝切除术后1d PLT<100×109/L是术后肝衰竭发生的重要危险因素。

Objective： To investigate the recovery of platelet count（ PLT） after hepatectomy for primary liver cancer（ PLC） and its clinical significance. Methods： The clinical data of 352 patients with PLC treated by hepatectomy were retrospectively analyzed. According to the PLT at 1 day after operation,the patients were divided into low PLT group（ 100 × 10^9/L） and normal group（ 100 ～ 300 × 10^9/L）. The relationships between PLT level and liver function recovery and the incidence of liver failure were analyzed. Results： Among the 352 patients with PLC,there were 98 cases（ 27. 84%） with low PLT and 254 cases（ 72. 16%） with normal PLT at 1 day after operation. The levels of ALT and AST in the low PLT group were higher than those in the normal PLT group at 1 day,3 days,5 days and 7 days after operation,while TBi L levels were higher than those in the normal PLT group at 1 day,3 days and 5 days after operation（ P〈0. 05）. Patients in liver failure group were older than patients in non-liver failure group,and the probabilities of PLT 〈100 × 10^9/L in 1 day after operation and Child-Pugh B grade of liver function were higher in the liver failure group than those in non-liver failure group（ P〈0. 05）. Multivariate Logisitic regression analysis showed that PLT 〈100 × 10^9/L in 1 day after operation and Child-Pugh B grade of liver function were independent risk factors for liver failure after hepatectomy. Conclusion： PLT〈 100 × 10^9/L in 1 day after hepatectomy is an important risk factor for liver failure.