Mohamud M, Osborne L, Jones H G, Ahmed A, Beynon J, Harris D A, Evans M, Davies M, Khot U, Chandrasekaran T V
Department of Surgery, Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea SA6 6NL, UK.
Gastroenterol Res Pract. 2018 Aug 26;2018:1978639. doi: 10.1155/2018/1978639. eCollection 2018.
Blood platelet measurement is a widely available and inexpensive test that is performed routinely. Platelets are thought to act by inducing inflammation and play a role in clotting and antimicrobial defence. A postoperative rise in the platelet count (thrombocytosis) is often dismissed as an incidental finding, but there is growing evidence to suggest that it may act as an indicator to underlying pathology. It correlates with significant pyogenic infections as well as multiple malignancies. In addition to this, recent research indicates that thrombocytosis may be a useful prognostic indicator for postoperative outcomes in patients with malignancies. In patients undergoing surgery for gastric cancer, a combination of platelet count and neutrophil-to-lymphocyte (NLR) ratio collected preoperatively was shown to correlate with postoperative survival.
To evaluate whether there is a positive correlation between pre- and postoperative thrombocytosis and the risk of complications following colorectal surgery.
This was a retrospective observational study based in Morriston Hospital, Swansea. Patients undergoing elective colorectal surgery for an 18-month period between 2014 and 2016 were included. Data on patient demographics, pre- and postoperative platelet count, the first date at which the highest platelet count was recorded, length of stay, type of operation, and postoperative complications using the Clavien-Dindo classification was obtained from the theatre booking software (TOMS) and Welsh Clinical Portal. Pearson's chi-square test was used for the analysis of the categorical variables.
Of the 201 patients studied, 75 (37%) had postoperative thrombocytosis (platelets ≥ 500 × 10/L, range 501-1136), 120 (59%) had postoperative normocytosis (platelets < 500 × 10/L, range 107-499), and 6 (2.9%) patients were excluded due to insufficient data. Peak platelet level was seen at a median of 8 days postoperatively but ranged from days 1 to 49. In patients with thrombocytosis, the mean time to peak platelet count was 9.5 days and ranged 1 to 49 days. 101/195 (52%) patients had a Clavien-Dindo III/V postoperative complication: 63% patients with postoperative normocytosis and 24% with postoperative thrombocytosis. In the thrombocytosis group, 16/75 (21%) were found to have postoperative pelvic collections compared to 1/120 (0.8%) of the normocytic patients. The total percentage of medical complications (44% versus 20%, = 0.006) and surgical complications (64% versus 15.8%, = 0.0001) was higher in the thrombocytosis group compared to the normocytosis group.
In this retrospective study, thrombocytosis was shown to have a positive correlation with postoperative medical and surgical complications. An elevated platelet count in the postoperative period should alert the clinician to a developing complication. We recommend that further studies with a larger sample size would test the specific associations with individual complications.
血小板检测是一项常规进行的、广泛应用且成本低廉的检测。血小板被认为通过引发炎症发挥作用，并在凝血和抗菌防御中起作用。术后血小板计数升高（血小板增多症）通常被视为偶然发现，但越来越多的证据表明它可能是潜在病理状况的一个指标。它与严重的化脓性感染以及多种恶性肿瘤相关。除此之外，近期研究表明血小板增多症可能是恶性肿瘤患者术后预后的一个有用指标。在接受胃癌手术的患者中，术前采集的血小板计数与中性粒细胞与淋巴细胞（NLR）比值的组合显示与术后生存率相关。
评估结直肠手术后术前和术后血小板增多症与并发症风险之间是否存在正相关。
这是一项基于斯旺西莫里森医院的回顾性观察研究。纳入了2014年至2016年期间接受择期结直肠手术的患者，为期18个月。从手术预订软件（TOMS）和威尔士临床门户网站获取患者人口统计学数据、术前和术后血小板计数、记录到最高血小板计数的首日、住院时间、手术类型以及使用Clavien-Dindo分类法的术后并发症数据。采用Pearson卡方检验分析分类变量。
在研究的201例患者中，75例（37%）术后出现血小板增多症（血小板≥500×10⁹/L，范围501 - 1136），120例（59%）术后血小板计数正常（血小板<500×10⁹/L，范围107 - 499），6例（2.9%）患者因数据不足被排除。术后血小板峰值水平出现在术后中位8天，但范围为1至49天。在血小板增多症患者中，血小板计数达到峰值的平均时间为9.5天，范围为1至49天。101/195（52%）例患者出现Clavien-Dindo III/V级术后并发症：术后血小板计数正常的患者中有63%，术后血小板增多症患者中有24%。在血小板增多症组中，16/75（21%）被发现有术后盆腔积液，而正常血小板计数组为1/120（0.8%）。与血小板计数正常组相比，血小板增多症组的医疗并发症总百分比（44%对20%，P = 0.006）和手术并发症总百分比（64%对15.8%，P = 0.0001）更高。
在这项回顾性研究中，血小板增多症与术后医疗和手术并发症呈正相关。术后血小板计数升高应提醒临床医生注意可能出现的并发症。我们建议进行更大样本量的进一步研究，以检验与个体并发症的具体关联。
