氬氦刀冷凍消融術(shù)治療中晚期原發(fā)性肝癌患者的血小板計(jì)數(shù)變化規(guī)律研究

鄧?yán)嫫剑倘鹞模钋飮?guó)，李 平

·論著·

氬氦刀冷凍消融術(shù)治療中晚期原發(fā)性肝癌患者的血小板計(jì)數(shù)變化規(guī)律研究

鄧?yán)嫫?，程瑞文，李秋國(guó)，李 平

目的 探討氬氦刀冷凍消融術(shù)治療中晚期原發(fā)性肝癌患者的血小板計(jì)數(shù)變化規(guī)律。方法 選取2013年7月—2016年6月湖南中醫(yī)藥大學(xué)第一附屬醫(yī)院收治的中晚期原發(fā)性肝癌患者60例，均行氬氦刀冷凍消融術(shù)(術(shù)前血小板計(jì)數(shù)≥50×109/L)治療，冷凍針布針1～3根者為A組，4～10根者為B組，11～15根者為C組?？偨Y(jié)A組、B組、C組術(shù)前、術(shù)后血小板計(jì)數(shù)變化規(guī)律。結(jié)果 A組術(shù)前和術(shù)后3、7、14 d的血小板計(jì)數(shù)比較，差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)；B組、C組術(shù)前和術(shù)后3、7、14 d的血小板計(jì)數(shù)比較，差異有統(tǒng)計(jì)學(xué)意義(P<0.05)；B組、C組術(shù)后3 d與術(shù)前血小板計(jì)數(shù)比較，差異有統(tǒng)計(jì)學(xué)意義(P<0.01)。由于A組術(shù)前和術(shù)后血小板計(jì)數(shù)變化不明顯，故僅對(duì)B組、C組患者按術(shù)前血小板計(jì)數(shù)再次分組，術(shù)前血小板計(jì)數(shù)≥50×109/L且<100×109/L定義為觀察組，血小板計(jì)數(shù)≥100×109/L定義為對(duì)照組。對(duì)照組和觀察組術(shù)前和術(shù)后3、7、14 d的血小板計(jì)數(shù)組內(nèi)比較，差異有統(tǒng)計(jì)學(xué)意義(P<0.05)；對(duì)照組、觀察組術(shù)后3 d與術(shù)前血小板計(jì)數(shù)比較，差異有統(tǒng)計(jì)學(xué)意義(P<0.01)。結(jié)論 氬氦刀冷凍消融術(shù)治療中晚期原發(fā)性肝癌，血小板計(jì)數(shù)≥50×109/L、冷凍針≤3根時(shí)血小板計(jì)數(shù)沒(méi)有明顯變化，4～15根時(shí)血小板計(jì)數(shù)表現(xiàn)為術(shù)后3 d下降到氬氦刀冷凍消融術(shù)前的50%左右，而術(shù)后7 d回升至術(shù)前水平,術(shù)后14 d保持穩(wěn)定。

肝腫瘤；冷凍外科手術(shù)；血小板

鄧?yán)嫫?，程瑞文，李秋?guó)，等.氬氦刀冷凍消融術(shù)治療中晚期原發(fā)性肝癌患者的血小板計(jì)數(shù)變化規(guī)律研究[J].中國(guó)全科醫(yī)學(xué)，2017，20(18)：2223-2226.[www.chinagp.net]

DENG L P,CHENG R W,LI Q G，et al.Platelet count change rule in medium-advanced primary hepatic carcinoma treated by argon-helium cryosurgery[J].Chinese General Practice，2017，20(18)：2223-2226.

我國(guó)大部分原發(fā)性肝癌患者發(fā)生于肝硬化背景下，部分患者合并脾功能亢進(jìn)，確診時(shí)多為中晚期，這些因素導(dǎo)致原發(fā)性肝癌的療效欠佳。近年來(lái)研究顯示，氬氦刀冷凍消融術(shù)治療中晚期原發(fā)性肝癌的療效較為理想[1-3]，最常見(jiàn)的并發(fā)癥是血小板計(jì)數(shù)減少[4]，但很少有氬氦刀冷凍消融術(shù)后血小板計(jì)數(shù)的研究，更罕見(jiàn)對(duì)血小板計(jì)數(shù)變化規(guī)律的研究報(bào)道。本研究旨在探討氬氦刀冷凍消融術(shù)治療中晚期原發(fā)性肝癌患者的血小板計(jì)數(shù)變化規(guī)律，現(xiàn)報(bào)道如下。

1 資料與方法

1.1 一般資料 選取2013年7月—2016年6月湖南中醫(yī)藥大學(xué)第一附屬醫(yī)院收治的中晚期原發(fā)性肝癌患者60例，其中男50例，女10例；年齡33～76歲，平均年齡(47.0±10.7)歲；均有乙肝、肝硬化病史。

1.2 診斷標(biāo)準(zhǔn) 患者均符合我國(guó)原衛(wèi)生部制定的《原發(fā)性肝癌診療規(guī)范(2011版)》中的相關(guān)診斷標(biāo)準(zhǔn)[5]。氬氦刀冷凍消融術(shù)條件[1-4]：(1)凝血常規(guī)中活化部分凝血活酶時(shí)間(APTT)、凝血酶原時(shí)間(PT)延長(zhǎng)至參考范圍下限2倍以內(nèi)，纖維蛋白原(FIB)正常，國(guó)際標(biāo)準(zhǔn)化比值(INR)1.5以內(nèi)；(2)肝功能按照Child-Pugh改良分級(jí)法評(píng)定為Child A級(jí)或者Child B級(jí)[6]；(3)臥位肝臟被膜外無(wú)腹腔積液；(4)白細(xì)胞計(jì)數(shù)≥3.0×105/L，血小板計(jì)數(shù)≥50×109/L；(5)近3個(gè)月無(wú)消化道大出血和外科手術(shù)史。

1.3 氬氦刀冷凍消融術(shù)方法 患者先行CT平掃+增強(qiáng)掃描以及MRI平掃+增強(qiáng)掃描，有強(qiáng)化的腫瘤病灶定義為腫瘤活性病灶[5]，測(cè)量腫瘤活性病灶最大直徑，制定氬氦刀冷凍消融術(shù)前的冷凍針布針?lè)桨?，布針原則：(1)冷凍針穿刺通道避開(kāi)肋骨、椎骨、胃腸道和膽囊。(2)冷凍針穿刺通道避開(kāi)重要神經(jīng)走行區(qū)域。(3)冷凍針穿刺通道避開(kāi)門(mén)靜脈和肝靜脈1、2級(jí)屬支。(4)腫瘤活性病灶最大直徑2.0 cm內(nèi)，布針≤3根；腫瘤最大直徑≥2.0 cm，按照間隔1.0～1.5 cm布針且單次累計(jì)布針≤15根。然后在CT引導(dǎo)下按照以上布針?lè)桨钢瘘c(diǎn)布好冷凍針，CT掃描驗(yàn)證布針結(jié)果與術(shù)前計(jì)劃方案吻合，再啟動(dòng)以色列Galil Medical Cryohit 冷凍系統(tǒng)給予氬氣冷凍消融15 min(壓力3 500 psi)，CT掃描檢測(cè)冷凍范圍，冰球覆蓋活性腫瘤病灶區(qū)域邊緣以達(dá)到減瘤滅

本文創(chuàng)新點(diǎn)：

(1)本研究對(duì)中晚期原發(fā)性肝癌的氬氦刀冷凍消融術(shù)治療過(guò)程中血小板計(jì)數(shù)動(dòng)態(tài)變化進(jìn)行研究。(2)對(duì)氬氦刀冷凍消融術(shù)按照冷凍針多寡進(jìn)行分組研究。(3)對(duì)氬氦刀冷凍消融術(shù)按照術(shù)前血小板計(jì)數(shù)進(jìn)行分組研究。(4)總結(jié)冷凍針4～15根時(shí)患者血小板計(jì)數(shù)變化規(guī)律。(5)提出血小板計(jì)數(shù)變化除與消耗有關(guān)外可能存在其他機(jī)制。

活活性腫瘤的目的[7]，氦氣復(fù)溫3 min(壓力2 500 psi)，再次重復(fù)一次冷凍和復(fù)溫過(guò)程，并再次CT掃描檢測(cè)冷凍范圍，拔針，壓迫止血并腹帶加壓包扎3 d，同時(shí)臥床休息。氬氣為廣州佛山華特公司生產(chǎn)，氦氣為美國(guó)林得公司生產(chǎn)，純度均為99.99%。1.4 分組標(biāo)準(zhǔn) 氬氦刀冷凍消融術(shù)后根據(jù)術(shù)中布針結(jié)果分組：布針1～3根者為A組(115例)，布針4～10根者為B組(36例)，布針11～15根者為C組(9例)。1.5 觀察指標(biāo) 觀察氬氦刀冷凍消融術(shù)不同冷凍針數(shù)量組在術(shù)前和術(shù)后3、7、14 d血小板計(jì)數(shù)。

2 結(jié)果

2.1 氬氦刀冷凍消融術(shù)布針情況 60例患者3個(gè)月內(nèi)無(wú)死亡病例，氬氦刀冷凍消融術(shù)布針情況詳見(jiàn)表1。

2.2A、B、C組術(shù)前、術(shù)后血小板計(jì)數(shù)比較A組術(shù)前和術(shù)后3、7、14d的血小板計(jì)數(shù)比較，差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)；B組、C組術(shù)前和術(shù)后3、7、14d的血小板計(jì)數(shù)組內(nèi)比較，差異有統(tǒng)計(jì)學(xué)意義(P<0.05)；B組、C組術(shù)后3d與術(shù)前血小板計(jì)數(shù)比較，差異有統(tǒng)計(jì)學(xué)意義(P<0.01，見(jiàn)表2)。由于A組術(shù)前和術(shù)后血小板計(jì)數(shù)變化不顯著，故僅對(duì)B組、C組患者按術(shù)前血小板計(jì)數(shù)再次分組，術(shù)前血小板計(jì)數(shù)≥50×109/L且<100×109/L定義為觀察組，血小板計(jì)數(shù)≥100×109/L定義為對(duì)照組。

2.3 對(duì)照組和觀察組術(shù)前、術(shù)后血小板計(jì)數(shù)比較 對(duì)照組和觀察組術(shù)前和術(shù)后3、7、14d的血小板計(jì)數(shù)組內(nèi)比較，差異有統(tǒng)計(jì)學(xué)意義(P<0.05)；其中對(duì)照組、觀察組術(shù)后3d與術(shù)前的血小板計(jì)數(shù)比較，差異有統(tǒng)計(jì)學(xué)意義(P<0.01，見(jiàn)表3)。

表1 氬氦刀冷凍消融術(shù)布針情況

Table1StatusofcryoneedlesusedingroupsA,BandCinargon-heliumcryosurgery

組別例數(shù)腫瘤活性病灶最大直徑(cm)冷凍針數(shù)量(根)A組151～2>1～3B組36>2～54～10C組 9 >5～1511～15

Table2PlateletcountchangeingroupsA,BandCduringtheperioperativeperiodofargon-heliumcryoablation

時(shí)間點(diǎn)A組(n=15)B組(n=36)C組(n=9)術(shù)前100.2±45.180.9±31.272.4±21.8術(shù)后3d95.6±34.640.1±27.9a35.8±12.6a術(shù)后7d98.4±42.377.9±30.671.2±20.8術(shù)后14d99.7±42.678.2±32.673.5±20.1F值0.021.844.11P值>0.05<0.05<0.05

注：與術(shù)前比較，aP<0.01

Table3Plateletcountchangeinthecontrolandobservationgroupsduringtheperioperativeperiodofargon-heliumcryoablation

時(shí)間點(diǎn)對(duì)照組(n=24)觀察組(n=21)術(shù)前120.7±16.875.2±23.5術(shù)后3d65.8±19.7a38.1±27.9a術(shù)后7d118.6±14.372.9±20.6術(shù)后14d119.8±20.274.5±18.5F值9.832.77P值<0.05<0.05

注：與術(shù)前比較，aP<0.01

3 討論

3.1 氬氦刀冷凍消融術(shù)治療中晚期原發(fā)性肝癌的現(xiàn)狀 近年來(lái)有較多對(duì)氬氦刀冷凍消融術(shù)的研究報(bào)道[8-10]，不斷印證了氬氦刀冷凍消融術(shù)治療中晚期原發(fā)性肝癌的確切療效[11-14]，其最常見(jiàn)的并發(fā)癥是血小板計(jì)數(shù)減少，甚至發(fā)生出血[15]，所以均強(qiáng)調(diào)氬氦刀冷凍消融術(shù)前血小板計(jì)數(shù)不低于100×109/L，但由于我國(guó)大部分原發(fā)性肝癌患者發(fā)生于肝硬化背景下，部分患者合并脾功能亢進(jìn)，血小板計(jì)數(shù)常低于100×109/L，導(dǎo)致該技術(shù)使用受限[5]。王玨瓊[6]總結(jié)肝硬化患者肝功能在Child A級(jí)和Child B級(jí)血小板計(jì)數(shù)分別為(70.36±15.67)×109/L和(61.35±11.62)×109/L，故本研究將血小板計(jì)數(shù)定義為≥50×109/L入組來(lái)研究，以期擴(kuò)大治療適應(yīng)證，使更多患者受益。目前國(guó)內(nèi)未查詢到對(duì)血小板計(jì)數(shù)低于100×109/L患者進(jìn)行研究的文獻(xiàn)，也未查詢到有關(guān)血小板計(jì)數(shù)變化規(guī)律的研究報(bào)道。

3.2 血小板計(jì)數(shù)的變化 本研究結(jié)果提示布針3根及以內(nèi)的氬氦刀冷凍消融術(shù)后14 d內(nèi)血小板計(jì)數(shù)變化不明顯，提示3根及以內(nèi)冷凍針形成冰球范圍內(nèi)的微血栓所消耗的血小板很快被機(jī)體代償，在血小板計(jì)數(shù)變化層面上是安全的。B組、C組(布針4～15根)氬氦刀冷凍消融術(shù)后3 d血小板計(jì)數(shù)顯著降低，分析與冷凍針數(shù)量增加時(shí)冰球范圍增大，形成微血栓增多，消耗血小板增加有關(guān)，理論上隨著冷凍針數(shù)量的增加消耗血小板數(shù)量相應(yīng)增加，因而理論上也應(yīng)該隨著冷凍針數(shù)量的增加術(shù)后血小板計(jì)數(shù)減少率相應(yīng)增加，但是結(jié)果B組、C組術(shù)后3 d血小板計(jì)數(shù)減少率均約為術(shù)前的50%，而術(shù)后7 d快速恢復(fù)，回升并穩(wěn)定到術(shù)前水平。提示血小板計(jì)數(shù)的變化與冷凍針(4～15根)數(shù)量的多少無(wú)明顯相關(guān)性。冷凍針的多寡在一定程度上與腫瘤的大小直接相關(guān)，故也提示氬氦刀冷凍消融術(shù)后血小板計(jì)數(shù)的變化在一定程度上與腫瘤的大小無(wú)明顯相關(guān)性，布針4～15根的血小板計(jì)數(shù)不同分組提示，每組氬氦刀冷凍消融術(shù)后3 d與術(shù)前血小板計(jì)數(shù)變化比較均有顯著下降，血小板計(jì)數(shù)減少率均約為術(shù)前的50%，而術(shù)后7 d快速恢復(fù)，回升并穩(wěn)定到術(shù)前水平，提示氬氦刀冷凍消融術(shù)后血小板計(jì)數(shù)的變化規(guī)律與術(shù)前(≥50×109/L)具體數(shù)值無(wú)明顯相關(guān)性，這些均提示氬氦刀冷凍消融術(shù)導(dǎo)致血小板計(jì)數(shù)減少除微血栓形成消耗血小板的這一機(jī)制外可能存在其他機(jī)制，有待進(jìn)一步研究證實(shí)。

綜上所述，氬氦刀冷凍消融術(shù)治療中晚期原發(fā)性肝癌，血小板計(jì)數(shù)≥50×109/L時(shí)，冷凍針數(shù)量≤3根血小板計(jì)數(shù)沒(méi)有明顯變化，4～15根血小板計(jì)數(shù)表現(xiàn)為術(shù)后3 d下降到氬氦刀冷凍消融術(shù)前的50%左右，而術(shù)后7 d回升并穩(wěn)定到術(shù)前水平，值得進(jìn)一步研究。

作者貢獻(xiàn)：鄧?yán)嫫竭M(jìn)行試驗(yàn)設(shè)計(jì)、資料收集整理、撰寫(xiě)論文并對(duì)文章負(fù)責(zé)；鄧?yán)嫫健⒊倘鹞?、李秋?guó)進(jìn)行試驗(yàn)實(shí)施、評(píng)估；李平進(jìn)行質(zhì)量控制及審校。

本文無(wú)利益沖突。

本文的不足之處：

(1)本研究屬小樣本研究，且僅對(duì)血小板計(jì)數(shù)進(jìn)行統(tǒng)計(jì)分析，未對(duì)血小板功能進(jìn)行檢測(cè)和統(tǒng)計(jì)分析。(2)使用的以色列Galil Medical Cryohit 冷凍系統(tǒng)，與美國(guó)冷凍系統(tǒng)未做對(duì)比分析。(3)本文是回顧性研究而非前瞻性對(duì)照研究。

[1]葉偉東,紀(jì)建松,涂建飛,等.氬氦刀冷凍消融聯(lián)合肝動(dòng)脈栓塞化療術(shù)治療中晚期肝癌的療效分析[J].介入放射學(xué)雜志,2015,24(5):392-395.DOI:10.3969/j.issn.1008-794X.2015.05.007. YE W D,JI J S,TU J F,et al.Argon-helium cryoablation combined with transcatheter arterial chemoembolization for the treatment of advanced hepatocellular carcinoma:analysis of therapeutic effectiveness[J].Journal of Interventional Radiology,2015,24(5):392-395.DOI:10.3969/j.issn.1008-794X.2015.05.007.

[2]莊煒釗，黃晨，姬智艷，等.TACE 聯(lián)合氬氦刀冷凍消融治療中晚期肝癌的療效分析[J].醫(yī)學(xué)影像學(xué)雜志，2016，26(12)：2247-2250. ZHUANG W Z，HUANG C，JI Z Y,et al.Analysis of therapeutic effetiveness of argon-helium cryoablation combined with transcatheter arterial chemoembolization for the treatment of advanced hepatocellular carcinoma[J].Journal of Medical Imaging，2016，26(12)：2247-2250.

[3]邱國(guó)欽，許麗貞，羅鵬飛,等.氬氦刀冷凍消融聯(lián)合TACE治療巨大肝癌的臨床觀察[J].臨床腫瘤學(xué)雜志，2015，20(6)：540-544. QIU G Q，XU L Z，LUO P F，et al.Clinical observation of argon-helium knife cryotherapy combined with transcatheter arterial chemoemboli-zation (TACE) on huge liver cancer[J].Chinese Clinical Oncology，2015，20(6)：540-544.

[4]程瑞文，鄧?yán)嫫?，李?等.TACE聯(lián)合氬氦刀冷凍消融術(shù)治療原發(fā)性肝癌后血小板觀察[J].中國(guó)中西醫(yī)結(jié)合影像學(xué)雜志，2016,14(2)：206-208.DOI:10.3969/j.issn.1672-0512.2016.02.028. CHENG R W,DENG L P,LI P,et al.Observation of platelet changes after TACE combined with argon-helium cryoablation in treatment of primary liver cance[J].Chinese Imaging Journal of Integrated Traditional and Western Medicine,2016,14(2)：206-208.DOI:10.3969/j.issn.1672-0512.2016.02.028.

[5]中華人民共和國(guó)衛(wèi)生部.原發(fā)性肝癌診療規(guī)范(2011版)[J].臨床腫瘤學(xué)雜志,2011,16(10):929-946.DOI:10.3969/j.issn.1009-0460.2011.10.017. Ministry of Public Health in China.Diagnosis and treatment of primary liver cancer (2011 edition)[J].Chinese Clinical Oncology,2011,16(10):929-946.DOI:10.3969/j.issn.1009-0460.2011.10.017.

[6]王玨瓊.血小板、凝血指標(biāo)與老年肝硬化患者Child-Pugh分級(jí)的關(guān)系[J].中國(guó)老年學(xué)雜志,2013,33(24)：6103-6105.DOI:10.3969/j.issn.1005-9202.2013.24.015. WANG J Q.The relationship between platelet,coagulation index and Child-Pugh grading in elderly patients with liver cirrhosis[J].Chinese Journal of Gerontology,2013,33(24)：6103-6105.DOI:10.3969/j.issn.1005-9202.2013.24.015.

[7]張積仁，Gregory Graves.氬氦刀靶向腫瘤治療技術(shù)[M].美國(guó)加州大學(xué)：先鋒生物科學(xué)出版社，2002，38. ZHANG J R,GRAVES G.Cryocare targeted cryoablation therapy[M].University of California:Pioneer Bioscience Publishing,2002，38.

[8]鄭澤華.肝動(dòng)脈化療栓塞聯(lián)合氬氦刀冷凍消融治療中晚期肝癌患者的療效觀察[J].現(xiàn)代診斷與治療,2015,26(20):4728-4729. ZHENG Z H.Clinical observation of transcatheter arterial chemoembolization combined with argon helium cryoablation in the treatment of patients with advanced hepatocellular carcinoma[J].Modern Diagnosis and Treatment,2015,26(20):4728-4729.

[9]沈立杰.射頻消融、氬氦刀冷凍對(duì)原發(fā)性肝癌治療效果的對(duì)比分析[J].醫(yī)學(xué)影像學(xué)雜志,2015,25(7):1216-1220. SHEN L J.Comparative analysis of treatment effect of primary hepatic carcinoma (PHC) by applying Ar-He Cryablation and radiofre-quency radiation[J].Journal of Medical Imaging,2015,25(7):1216-1220.

[10]陳習(xí)波,宋華志,何遠(yuǎn)春，等.氬氦刀冷凍消融聯(lián)合肝動(dòng)脈插管化療栓塞治療原發(fā)性肝癌的療效研究[J].實(shí)用癌癥雜志，2015，30(11)：1710-1712.DOI:10.3969/j.issn.1001-5930.2015.11.038. CHEN X B,SONG H Z,HE Y C,et al.Efficacy of argon-helium cryoablation combined with transcatheter arterial chemoembolization in the treatment of primary hepatic cancer[J].The Practical Journal of Cancer,2015,30(11)：1710-1712.DOI:10.3969/j.issn.1001-5930.2015.11.038.

[11]劉秋華，周革階，張伯，等.TACE聯(lián)合氬氦刀冷凍治療原發(fā)性肝癌臨床分析[J].肝膽胰外科雜志，2014，26(4)：278-280. LIU Q H,ZHOU G J,ZHANG B,et al.Clinical analysis of primary hepatic carcinoma treated by TACE combined with cryoablation[J].Journal of Hepatopancreatobiliary Surgery,2014,26(4)：278-280.

[12]侯曉瑋，宋謙，李露嘉，等.TACE 聯(lián)合氬氦冷凍消融治療原發(fā)性肝癌效果觀察[J].實(shí)用醫(yī)藥雜志，2013， 30(4)：293-295.DOI:10.3969/j.issn.1671-4008.2013.04.003. HOU X W，SONG Q，LI L J,et al.The efficacy of primary hepatic carcinoma treated by TACE combined with argon-helium cryoablation[J].Practical Journal of Medicine & Pharmacy,2013,30(4)：293-295.DOI:10.3969/j.issn.1671-4008.2013.04.003.

[13]徐穩(wěn)深，吳陽(yáng)，嚴(yán)雙喜.肝癌冷凍消融治療的臨床應(yīng)用分析[J].包頭醫(yī)學(xué)院學(xué)報(bào),2016,32(5):16-17. XU W S，WU Y，YAN S X.Analysis of the clinical application of cryoablation for liver cancer[J].Journal of Baotou Medical College,2016,32(5):16-17.

[14]王成虎,徐高峰,吉洪海,等.氬氦刀冷凍聯(lián)合肝動(dòng)脈化療栓塞治療原發(fā)性肝癌的對(duì)照研究[J].齊齊哈爾醫(yī)學(xué)院學(xué)報(bào),2015,36(33):5043-5045. WANG C H,XU G F,JI H H,et al.Control study on argon-helium cryotherapy combine hepatic arterial chemoembolization of primary liver cancer[J].Journal of Qiqihar University of Medicine，2015,36(33):5043-5045.

[15]易峰濤，盧綺萍，吳坤.氬氦刀治療實(shí)驗(yàn)性肝腫瘤并發(fā)出血的原因研究[J].中國(guó)臨床研究,2016,29(2):166-168.DOI:10.13429/j.cnki.cjcr.2016.02.006. YI F T,LU Q P，WU K.Reasons of hemorrhage after argon-helium cryoablation in rabbits with experimental liver tumor[J].Chinese Journal of Clinical Research,2016,29(2):166-168.DOI:10.13429/j.cnki.cjcr.2016.02.006.

(本文編輯：崔莎)

Platelet Count Change Rule in Medium-advanced Primary Hepatic Carcinoma Treated by Argon-helium Cryosurgery

DENGLi-ping*,CHENGRui-wen,LIQiu-guo，LIPing

VascularandOncologyInterventionalDepartment，theFirstHospitalofHunanUniversityofChineseMedicine,Changsha410007,China

Objective To explore the platelet count change rule of medium-advanced primary hepatic carcinoma treated by argon-helium cryosurgery.Methods Sixty cases with medium-advanced primary hepatic carcinoma admitted in the First Hospital of Hunan University of Chinese Medicine from July 2013 to June 2016 were selected as the participants.All of them had preoperative platelet count equal to or greater than 50×109/L,and

argon-helium cryosurgery.Based on the number of cryoneedles used in the surgery,they were divided into group A(using 1-3 cryoneedles),group B(using 4-10 cryoneedles),group C(using 11-15 cryoneedles ).The postoperative platelet count change rules in groups A,B and C were summarized.Results Platelet count measured before the surgery,at 3,7,14 d after the surgery differed significantly in groups B and C(P<0.05),but not in group A(P>0.05).Platelet count measured before the surgery was obviously different from that measured at 3 d after the surgery in both groups B and C(P<0.01).As the change of platelet count was obvious in groups B and C,so we further studied the change of it in them.Patients with platelet count level lower than 100×109/L but equal to or greater than 50×109/L and those with it equal to or greater than 100×109/L in group B and group C were assigned to the observation group and control group,respectively.Platelet count measured before the surgery,at 3,7,14 d after the surgery differed significantly in both the observation group and control group (P<0.05).Significant differences were found between the platelet count measured before the surgery and that measured at 3 d after the surgery in both the observation group and control group (P<0.01).Conclusion During the perioperative period of argon-helium cryosurgery for medium-advanced primary hepatic carcinoma patients whose preoperative platelet count levels were equal to or greater than 50×109/L,platelet count did not change significantly in those used 1-3 cryoneedles,but in those used 4～15 cryoneedles,it dropped by almost half of the preoperative level at the 3rd day after surgery,then elevated to the preoperative level at the 7th day after surgery,and remained stable at the 14th day after surgery.

Liver neoplasms;Cryosurgery;Blood platelet

湖南省衛(wèi)計(jì)委資助項(xiàng)目(C2016051)

R 735.7

A

10.3969/j.issn.1007-9572.2017.18.011

2016-09-08；

2017-02-28)

410007湖南省長(zhǎng)沙市，湖南中醫(yī)藥大學(xué)第一附屬醫(yī)院血管腫瘤介入科

*通信作者：鄧?yán)嫫?，副主任醫(yī)師；E-mail:13875788233@163.com

*Correspondingauthor:DENGLi-ping，Associatechiefphysician；E-mail:13875788233@163.com