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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2025, Vol. 14 ›› Issue (04) : 576 -581. doi: 10.3877/cma.j.issn.2095-3232.2025.04.012

临床研究

术前输注血小板在肝癌合并肝硬化门静脉高压症肝脾联合切除患者中的疗效
张宏伟1, 邢玉雪2, 贾哲1, 赫嵘1, 张珂1, 蒋力1,†()   
  1. 1100015　首都医科大学附属北京地坛医院普通外科
    2100015　首都医科大学附属北京地坛医院放射科
  • 收稿日期:2025-01-11 出版日期:2025-08-10
  • 通信作者: 蒋力

Clinical efficacy of platelet transfusion before liver and spleen resection in hepatocellular carcinoma patients complicated with cirrhotic portal hypertension

Hongwei Zhang1, Yuxue Xing2, Zhe Jia1, Rong He1, Ke Zhang1, Li Jiang1,†()   

  1. 1Department of General Surgery, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
    2Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2025-01-11 Published:2025-08-10
  • Corresponding author: Li Jiang
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引用本文：

张宏伟, 邢玉雪, 贾哲, 赫嵘, 张珂, 蒋力. 术前输注血小板在肝癌合并肝硬化门静脉高压症肝脾联合切除患者中的疗效[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(04): 576-581.

Hongwei Zhang, Yuxue Xing, Zhe Jia, Rong He, Ke Zhang, Li Jiang. Clinical efficacy of platelet transfusion before liver and spleen resection in hepatocellular carcinoma patients complicated with cirrhotic portal hypertension[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(04): 576-581.

目的

探讨术前输注血小板对预防肝细胞癌（肝癌）合并肝硬化门静脉高压症肝脾联合切除患者术中和术后出血的疗效。

方法

回顾性分析2010年1月至2024年1月在首都医科大学附属北京地坛医院行肝脾联合切除术的118例肝癌合并肝硬化门静脉高压症患者的临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男70例，女48例；年龄35~68岁，中位年龄57岁。根据术前是否输注血小板分为血小板输注组和血小板未输注组。依据术前Plt分3个亚组，分别为≤30×109/L、31~49×109/L、≥50×109/L。分析血小板输注对不同Plt分层亚组的术中出血量、术后腹腔引流量、血红蛋白损失量、术后出血发生率、住院时间等指标影响，以及对促进术后血小板恢复的作用。两组比较采用t检验和χ2检验。

结果

亚组分层分析显示，与血小板未输注组比较，对于Plt≤30×109/L患者，血小板输注组术中出血量、术后2 d腹腔引流总量、血红蛋白损失量明显减少，住院时间明显缩短（t=-3.596，-3.316，-4.000，-4.815；P<0.05），术后出血发生率明显降低（χ2=5.051，P<0.05）；对于Plt 31~49×109/L和≥50×109/L亚组患者，两组差异均无统计学意义（P<0.05）。术后1、24 h，血小板输注组的Plt明显高于血小板未输注组（t=6.410，8.583；P<0.05）；而术后48 h、7 d，两组Plt之间差异无统计学意义（P>0.05）。

结论

对于术前Plt≤30×109/L的肝癌合并肝硬化门静脉高压症患者，术前血小板输注能有效止血，术前应常规血小板输注；术前Plt>30×109/L时，不建议术前常规输注血小板，且术前输注血小板对长期血小板水平的影响不明显。

关键词: 癌，肝细胞, 肝硬化, 门静脉高压症, 肝脾联合切除术, 血小板输注
Objective

To assess clinical efficacy of platelet transfusion before liver and spleen resection in preventing intraoperative and postoperative bleeding for hepatocellular carcinoma (HCC) patients complicated with cirrhotic portal hypertension.

Methods

Clinical data of 118 HCC patients complicated with cirrhotic portal hypertension who underwent combined liver and spleen resection in Beijing Ditan Hospital affiliated to Capital Medical University from January 2010 to January 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 70 patients were male and 48 female, aged from 35 to 68 years, with a median age of 57 years. According to whether platelet transfusion was performed before surgery, all patients were divided into the platelet transfusion and non-platelet transfusion groups. According to preoperative platelet (Plt) count, the patients were divided into three stratified subgroups of Plt≤30×109/L, 31-49×109/L and ≥50×109/L groups, respectively. The effect of platelet transfusion on intraoperative bleeding, postoperative abdominal drainage, hemoglobin loss, incidence of postoperative bleeding, length of hospital stay and other indexes was analyzed in different stratified subgroups, and its role in promoting postoperative platelet recovery was assessed. Two-group comparison was performed by t-test and Chi-square test.

Results

Subgroup analysis showed that compared with non-platelet transfusion group, intraoperative blood loss, the total amount of abdominal drainage at postoperative 2 d and hemoglobin loss were significantly reduced and the length of hospital stay was significantly shortened (t=-3.596, -3.316, -4.000, 4.815; all P<0.05), and the incidence of postoperative bleeding was decreased in patients with Plt ≤30×109/L (χ2=5.051, P<0.05). The differences were not statistically significant between the Plt 31-49×109/L and ≥50×109/L subgroups (both P<0.05). At postoperative 1 and 24 h, Plt in the platelet transfusion group was significantly higher than that in the non-platelet transfusion group (t=6.410, 8.583; both P<0.05), whereas no significant difference was noted in Plt at postoperative 48 h and 7 d between two groups (both P>0.05).

Conclusions

For HCC patients complicated with cirrhotic portal hypertension with preoperative Plt ≤30×109/L, preoperative platelet transfusion can effectively stop bleeding. Routine platelet transfusion should be conducted before surgery. However, routine platelet transfusion is not recommended for patients with preoperative Plt >30×109/L. Preoperative platelet transfusion exerts insignificant effect upon long-term Plt level.

Key words: Carcinoma,hepatocellular, Cirrhosis, Portal hypertension, Combined hepatectomy and splenectomy, Platelet transfusion
表1 两组合并肝硬化门静脉高压症肝癌患者肝脾联合切除术前基线资料比较
指标 血小板输注组 血小板未输注组 统计值 P值
年龄(岁,±s) 56±8 55±8 t=0.39 0.694
男性(例) 36 34 χ2=0.02 0.879
食管静脉曲张程度(例)     χ2=0.25 0.882
轻度 8 6    
中度 21 21    
重度 31 31    
食管胃底静脉黏膜红色征阳性(例) 40 36 χ2=0.27 0.602
术前呕血或黑便(例) 32 32 χ2=0.04 0.841
腹水(例) 26 27 χ2=1.23 0.539
脾脏长度(cm,±s) 190±38 183±31 t=1.17 0.245
肿瘤位置(左半肝/右半肝) 29/31 25/33 χ2=0.33 0.569
肿瘤直径(cm,±s) 3.4±0.9 3.7±0.9 t=0.99 0.326
PT(s,±s) 15.3±1.3 14.7±1.4 t=1.74 0.085
PTA(%,±s) 53±7 55±5 t=-1.67 0.097
Child-Pugh分级A级(例) 43 39 χ2=0.27 0.602
表2 肝癌合并肝硬化门静脉高压症患者术前血小板输注对围手术期指标影响分层分析
分层 血小板输注组(例) 血小板未输注组(例) 术中出血量(ml,±s) t值 P值 术后2 d腹腔引流总量(ml,±s) t值 P值
血小板输注组 血小板未输注组 血小板输注组 血小板未输注组
A层 10 10 850±158 1 135±194 -3.596 0.002 801±109 1 080±243 -3.316 0.006
B层 26 18 679±198 742±193 -1.047 0.301 755±155 763±134 -0.176 0.861
C层 24 30 648±143 633±133 0.386 0.701 747±122 761±144 -0.389 0.699
合计 60 58 695±183 754±244 -1.478 0.071 760±133 808±192 -1.595 0.057
分层 血小板输注组(例) 血小板未输注组(例) 血红蛋白损失量(g,±s) t值 P值 住院时间(d,±s) t值 P值
血小板输注组 血小板未输注组 血小板输注组 血小板未输注组
A层 10 10 2.4±0.9 4.0±0.8 -4.000 0.001 13.8±2.9 19.5±2.4 -4.815 <0.001
B层 26 18 2.1±0.4 2.3±0.5 -1.566 0.125 11.4±1.8 12.3±1.7 -1.601 0.117
C层 24 30 1.9±0.5 2.0±0.6 -0.284 0.778 11.5±1.3 12.2±1.7 -1.735 0.080
合计 60 58 2.1±0.6 2.3±0.9 -1.554 0.062 11.8±2.1 12.7±3.6 -1.557 0.061
分层 血小板输注组(例) 血小板未输注组(例) 术后出血(例) χ 2值 P值
血小板输注组 血小板未输注组
A层 10 10 2 7 5.051 0.025
B层 26 18 4 5 1.004 0.316
C层 24 30 3 4 0.008 0.928
合计 60 58 9 16 2.095 0.143
表3 肝癌合并肝硬化门静脉高压症患者肝脾联合切除术前Plt与术中出血量相关性分析
分层 血小板输注组术中出血量(ml) 血小板未输注组术中出血量(ml)
<700 700~1 000 >1 000 <700 700~1 000 >1 000
A层 2 6 2 0 3 7
B层 18 8 0 9 7 2
C层 17 7 0 21 9 0
rs值 -0.226 -0.641
P值 0.082 <0.001
表4 两组合并肝硬化门静脉高压症肝癌患者围手术期不同时间点Plt比较
组别 例数 术前 术后1 h 术后24 h 术后48 h 术后7 d F值 P值
血小板输注组 60 46±13 91±20a 146±27a 208±45a 340±69a 18.007 <0.001
血小板未输注组 58 50±15 69±18a 101±32a 200±53a 319±80a 13.484 <0.001
t值   -1.753 6.410 8.583 0.886 1.479    
P值   0.082 <0.001 <0.001 0.378 0.142    
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