Takahashi Kazuhiro, Kurokawa Tomohiro, Oshiro Yukio, Fukunaga Kiyoshi, Sakashita Shingo, Ohkohchi Nobuhiro
Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, University of Tsukuba.
Tohoku J Exp Med. 2016 May;239(1):47-55. doi: 10.1620/tjem.239.47.
Peripheral platelet counts decrease after partial hepatectomy; however, the implications of this phenomenon are unclear. We assessed if the observed decrease in platelet counts was associated with postoperative liver function and morbidity (complications grade ≤ II according to the Clavien-Dindo classification). We enrolled 216 consecutive patients who underwent partial hepatectomy for primary liver cancers, metastatic liver cancers, benign tumors, and donor hepatectomy. We classified patients as either low or high platelet percentage (postoperative platelet count/preoperative platelet count) using the optimal cutoff value calculated by a receiver operating characteristic (ROC) curve analysis, and analyzed risk factors for delayed liver functional recovery and morbidity after hepatectomy. Delayed liver function recovery and morbidity were significantly correlated with the lowest value of platelet percentage based on ROC analysis. Using a cutoff value of 60% acquired by ROC analysis, univariate and multivariate analysis determined that postoperative lowest platelet percentage ≤ 60% was identified as an independent risk factor of delayed liver function recovery (odds ratio (OR) 6.85; P < 0.01) and morbidity (OR, 4.90; P < 0.01). Furthermore, patients with the lowest platelet percentage ≤ 60% had decreased postoperative prothrombin time ratio and serum albumin level and increased serum bilirubin level when compared with patients with platelet percentage ≥ 61%. A greater than 40% decrease in platelet count after partial hepatectomy was an independent risk factor for delayed liver function recovery and postoperative morbidity. In conclusion, the decrease in platelet counts is an early marker to predict the liver function recovery and complications after hepatectomy.
肝部分切除术后外周血小板计数会下降；然而，这一现象的影响尚不清楚。我们评估了观察到的血小板计数下降是否与术后肝功能及发病率（根据Clavien-Dindo分类法，并发症等级≤II级）相关。我们纳入了216例连续接受肝部分切除术的患者，这些患者因原发性肝癌、转移性肝癌、良性肿瘤及供肝切除术而接受手术。我们使用通过受试者工作特征（ROC）曲线分析计算出的最佳临界值，将患者分为低血小板百分比组或高血小板百分比组（术后血小板计数/术前血小板计数），并分析肝切除术后肝功能延迟恢复及发病率的危险因素。基于ROC分析，肝功能延迟恢复及发病率与血小板百分比的最低值显著相关。使用ROC分析得出的临界值60%，单因素和多因素分析确定术后最低血小板百分比≤60%被确定为肝功能延迟恢复（比值比（OR）6.85；P<0.01）及发病率（OR，4.90；P<0.01）的独立危险因素。此外，与血小板百分比≥61%的患者相比，最低血小板百分比≤60%的患者术后凝血酶原时间比值及血清白蛋白水平降低，血清胆红素水平升高。肝部分切除术后血小板计数下降超过40%是肝功能延迟恢复及术后发病率的独立危险因素。总之，血小板计数下降是预测肝切除术后肝功能恢复及并发症的早期指标。
