Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China.
Cryobiology. 2013 Oct;67(2):146-50. doi: 10.1016/j.cryobiol.2013.06.004. Epub 2013 Jul 4.
Coagulopathy after liver cryoablation was first reported many years ago; the cause is local platelet trapping and destruction within the margin of the cryolesion. However, the prognosis and therapeutic effects of coagulopathy remain unclear. This study retrospectively reviewed clinical data from 372 patients (525 sessions) who underwent liver cryoablation in our hospital during the past 4.5 years. Small tumors (major diameter < 6 cm) were treated with a single complete ablation; massive tumors (major diameter 6-10 cm or >10 cm) were divided into two or three parts that were dealt with in turn. Platelet counts decreased to an average of (46.12 ± 68.13) × 10(9)/L after each session of cryoablation. The decline was most evident in patients with high pretreatment platelet counts, while those with low pretreatment counts had the highest risk of coagulopathy. Change in platelet count was not correlated with the diameter of the tumor. Slight coagulopathy (platelet count (70-100) × 10(9)/L) can resolve without treatment within 1 week and administration of recombinant human interleukin-11 can assist recovery from severe coagulopathy (platelet count < 70 × 10(9)/L).
肝冷冻消融术后凝血功能障碍早在多年前就有报道；其原因是在冷冻损伤边缘的局部血小板捕获和破坏。然而，凝血功能障碍的预后和治疗效果仍不清楚。本研究回顾性分析了过去 4.5 年我院 372 例（525 例次）接受肝冷冻消融治疗的患者的临床资料。小肿瘤（最大直径<6cm）采用单次完全消融治疗；大肿瘤（最大直径 6-10cm 或>10cm）分为两部分或三部分依次处理。每次冷冻消融后血小板计数平均下降至（46.12±68.13）×109/L。血小板计数较高的患者下降最为明显，而血小板计数较低的患者发生凝血功能障碍的风险最高。血小板计数的变化与肿瘤的直径无关。轻度凝血功能障碍（血小板计数（70-100）×109/L）无需治疗，可在 1 周内自行缓解，重组人白细胞介素-11 可辅助治疗严重凝血功能障碍（血小板计数<70×109/L）。
