门静脉高压脾功能亢进患者手术前后血小板的变化及处理.DOCVIP

临床医学论文-门静脉高压脾功能亢进患者手术前后血小板的变化及处理 ??????????? 作者：李桂中，许安荣，李常恩，高天祥 【摘要】? 目的 探讨门静脉高压性脾功能亢进患者手术前后血小板变化的影响因素与临床意义。方法 回顾性分析我院1993年1月～2006年10月行脾脏切除（A组）和非脾脏手术（B组）的61例门脉性脾亢患者以及同期17例外伤脾切除（C组）前后患者血小板变化情况。结果 A组术前血小板为（42.7±12.9）×109/L，B组为（49.5±14.1）×109/L，分别27.9%（12/43）和33.3%（6/18）伴APTT延长。C组为（209.2±76.4）×109/L。术后第7日A、B、C三组血小板分别为（431.5±52.1）×109/L、（33.9±10.2）×109/L和（715.6±68.9）×109/L，A组与B组及A组与C组相比较差异均有显著统计学意义（P0.01）。A组发生肠系膜上静脉血栓形成4例，早期溶栓治疗后治愈。腹水外漏7例，肝衰竭5例，死亡3例。B组腹水外漏5例，皮下积液5例，肝衰竭2例，无死亡病例。结论 正确认识肝硬化时促血小板生成素（thrombopoietin，TPO）降低在血小板减少症中的作用对于有效处理脾功能亢进患者各种手术前后血小板变化所导致的不同凝血功能障碍有重要意义。 【关键词】? 门静脉高压症；脾功能亢进；血小板 ??? Management of platelet changes in hypersplenia following portal hypertention in perioperative ??? ［Abstract］? Objective? To explore the affected factors with the clinical significance of platelet（PLT） count changes in hypersplenia following portal hypertention in perioperative.Methods? The PLT changes in perioperative of 61 cases with hypersplenia following portal hypertention for splenectomy（group A） or the other operation （group B） were retrospectively analyzed，so did 17 cases with splenic rupture （group C） the same term.Results? Preoperatively the PLT in group A were（42.7±12.9）×109/L and in group B were（49.5±14.1）×109/L.The APTT prolongation? were in 12 cases（27.9%），6 cases （33.3%） respectly.In group C it were（209.2±76.4）×109/L.The data of PLT in group A，B and C were（431.5±52.1）×109/L，（33.9±10.2）×109/L and（715.6±68.9）×109/L respectly at the 7th day.Both compared group A with B and A with C the difference being significant （P0.01）.In group A there were 4 cases of mesenteric vein thrombosis cured by early anti-coagulation and thrombolytic therapy，7 cases of ascites exude，5 cases of liver failure，and 3 died.In group B there were 5cases of ascites exude，5 cases of subcutaneous seroma，3 cases of liver failure and no one died.Conclusion? Decreasing of TPO in hepatic cirrbosis is the main factors of thrombocytopoiesis.It is the clinical significance to correctly understand PLT cha