Noji Takehiro, Tsuchikawa Takahiro, Ebihara Yuma, Nakamura Toru, Kato Kentaro, Matsumoto Joe, Tanaka Eiichi, Shichinohe Toshiaki, Hirano Satoshi
Department of Gastroenterological Surgery II, Graduate School of Medicine, Hokkaido University, N15W7, Kita-ku, Sapporo Hokkaido 060-8638, Japan.
BMC Surg. 2014 Oct 16;14:81. doi: 10.1186/1471-2482-14-81.
Post-operative anastomotic insufficiency following major hepato-biliary surgery has significant impacts on the post-operative course. Recent reports have revealed that platelets play an important role in liver regeneration and wound healing. From these experimental and clinical results on platelet function, we hypothesized that post-operative platelet depletion (to <10 × 104/μL) would be associated with delayed liver regeneration as well as anastomotic insufficiency of intrahepatic cholangiojejunostomy. However, little information is available regarding correlations between platelet count and these complications. The purposes of the present study were, firstly, to evaluate the incidence of anastomotic insufficiency following intrahepatic cholangiojejunostomy and, secondly, to evaluate whether platelet depletion represents a risk factor for anastomotic insufficiency in intrahepatic cholangiojejunostomy.
Participants in this study comprised 220 consecutive patients who underwent intrahepatic cholangiojejunostomy following hepato-biliary resection for biliary malignancies between September 1998 and December 2010. Anastomotic insufficiency was confirmed by cholangiographic demonstration of leakage from the anastomosis using contrast medium introduced via a biliary drainage tube or prophylactic drain placed during surgery.
Anastomotic insufficiency of the intrahepatic cholangiojejunostomy occurred in 13 of 220 patients (6%). Thirteen of the 220 patients, including one with anastomotic insufficiency, died during the study. Uni- and multivariate analyses both revealed that platelet depletion on post-operative day 1 (<10 × 104/μL) correlated with anastomotic insufficiency.
Post-operative platelet depletion was closely associated with anastomotic insufficiency following intrahepatic cholangiojejunostomy. This correlation has been established, but the underlying mechanisms have not.
大型肝胆手术后的吻合口漏对术后病程有重大影响。近期报告显示，血小板在肝脏再生和伤口愈合中起重要作用。基于这些关于血小板功能的实验和临床结果，我们推测术后血小板减少（至<10×10⁴/μL）可能与肝再生延迟以及肝内胆管空肠吻合口漏有关。然而，关于血小板计数与这些并发症之间的相关性，目前所知甚少。本研究的目的，一是评估肝内胆管空肠吻合术后吻合口漏的发生率，二是评估血小板减少是否为肝内胆管空肠吻合术吻合口漏的危险因素。
本研究的参与者包括1998年9月至2010年12月期间因胆道恶性肿瘤行肝胆切除术后连续接受肝内胆管空肠吻合术的220例患者。通过经术中放置的胆道引流管或预防性引流管注入造影剂，经胆管造影证实吻合口漏来确定吻合口漏。
220例患者中有13例（6%）发生肝内胆管空肠吻合口漏。220例患者中有13例在研究期间死亡，其中1例有吻合口漏。单因素和多因素分析均显示，术后第1天血小板减少（<10×10⁴/μL）与吻合口漏相关。
术后血小板减少与肝内胆管空肠吻合术后的吻合口漏密切相关。这种相关性已得到证实，但潜在机制尚不清楚。
