肝豆状核变性合并脾亢患者脾切除前后血小板变化及其临床意义

Changes and Clinical Significance of Platelet in Patients with Hepatolenticular Degeneration and Hypersplenism before and after Operation

目的:研究肝豆状核变性(hepatolenticular degeneration,HLD)合并脾功能亢进(以下简称脾亢)患者围手术期血小板(blood platelet,PLT)的变化规律并分析其临床意义。方法:选择2014年8月—2017年8月在我院行脾切除术的77例HLD合并脾亢患者,观察脾切除术前后血小板和的变化及其术后D-二聚体(D dimer,D-D)变化和血栓发生情况。结果:脾切除术后PLT和D-D升高明显。术后1 d,多数患者(70.1%)PLT恢复到正常范围,所有患者(100%)D-D均超过正常范围;术后7 d,77例患者(100%)PLT都恢复到正常范围及其以上。与术前相比,差异有统计学意义(P<0.05)。术后门静脉系统血栓(portal vein system thrombosis,PVST)的发生率为67.5%。其中术后7 d为41.5%,术后14 d为26.0%。结论:脾切除术后HLD合并脾功患者PLT明显升高,达到了手术目的,满足了内科驱铜治疗。但随着PLT升高,D-D水平上升,血液凝固性增加,易形成PVST,严重影响了患者术后的恢复,临床上需提前干预,预防PVST的发生。

Objective:To study the change of platelet during splenectomy in patients with hepatolenticular degeneration and hypersplenism,and analyze its clinical significance. Methods:To observe the change of platelet and D dimer and the postoperative thrombosis in 77 patients with hypersplenism which the splenectomy was performed in our hospital from August 2014 to August 2017. Results:The increase of PLT and D-D was obvious after splenectomy. The first day after the operation,most of the patients(70.1%)returned to normal range of PLT,and the D-D of all patients(100%)exceed normal range. Seventh days after the operation,the PLT of 77 patients(100%)returned to normal range and above. The difference was statistically significant compared with the preoperative(P<0.05). The incidence of portal vein system thrombosis(PVST)after operation was 67.5%. Among them,seventh days after operation were 41.5%,fourteenth days after operation were 26%. Conclusion:After splenectomy,the PLT of patients with HLD combined with hypersplenism increased significantly,reaching the purpose of operation and satisfying the medical treatment of copper flooding. However,with the increase of PLT,the level of D-D increased,the coagulation of blood increased,and PVST was easily formed,which seriously affected the recovery of the patients after operation. It was necessary to intervene early in clinical and prevent the occurrence of PVST.