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目的探讨肝肿瘤经皮冷冻术后发生血小板减少的相关因素并对治疗手段进行评价。方法回顾性分析372例行肝肿瘤经皮冷冻术患者术后血小板减少的情况,对肿瘤消融直径、血小板减少的发生率、术前血小板计数和血小板最大减少值的相关性进行线性回归分析。结果全部患者冷冻术均顺利完成,术后未出现严重并发症。372例患者共施行肝肿瘤经皮冷冻术525次。术后发生血小板减少症96例(18.3%)。患者血小板计数最大减少值为[41.0(10.0,82.6)]×109·L-1。冷冻术前血小板计数与术后血小板减少症的发生率呈负相关(P=0.033 2)。术前血小板水平范围为(350~650)×109·L-1的患者术后血小板最大减少值较高。肿瘤消融直径与术后血小板减少症的发生率、血小板最大减少值和术前血小板计数均无相关(P=0.347 1、P=0.293 3和P=0.518 8)。轻微血小板减少症的患者可在术后6 d自行缓解或恢复,严重血小板减少症的患者经重组人白细胞介素-11(rhIL-11)治疗7 d后恢复。结论经皮冷冻治疗肝脏肿瘤会引起血小板减少。术前血小板水平较低的患者在冷冻术后血小板减少症的发生率较高。rhIL-11对治疗肝肿瘤冷冻术后严重血小板减少有效。
Objective To investigate the related factors of thrombocytopenia after percutaneous freezing of liver tumors and to evaluate the treatment methods. Methods The postoperative thrombocytopenia in 372 patients who underwent percutaneous freezing surgery was retrospectively analyzed. The linear regression analysis was performed on the correlation between tumor ablation diameter, thrombocytopenia, preoperative platelet count and maximum platelet reduction. Results All patients were successfully completed cryosurgery, postoperative no serious complications. 372 patients performed a total of 525 percutaneous frozen liver tumors. Postoperative thrombocytopenia occurred in 96 cases (18.3%). The maximum reduction of platelet count was [41.0 (10.0,82.6)] × 109 · L-1. There was a negative correlation between platelet count and the incidence of postoperative thrombocytopenia (P = 0.033 2). Preoperative platelet levels range (350 ~ 650) × 109 · L-1 in patients with the highest postoperative platelet reduction. There was no correlation between tumor ablation diameter and the incidence of postoperative thrombocytopenia, maximum platelet reduction and preoperative platelet count (P = 0.347 1, P = 0.293 3 and P = 0.518 8). Patients with mild thrombocytopenia were able to relieve or recover on their own at 6 days after operation. Patients with severe thrombocytopenia recovered after 7 days of rhIL-11 treatment. Conclusion Percutaneous freezing treatment of liver tumors can cause thrombocytopenia. Patients with lower preoperative platelet levels have a higher incidence of thrombocytopenia after cryosurgery. rhIL-11 is effective in treating severe thrombocytopenia after liver tumor freezing.