腹腔镜肝切除术治疗合并血小板减少肝细胞癌患者的疗效和安全性

目的探讨腹腔镜肝切除(laparoscopic liver resection，LLR)对合并血小板减少肝细胞癌患者的有效性及安全性。 方法回顾性分析2020年4月至2022年11月首都医科大学附属北京佑安医院因肝细胞癌行LLR的141例患者临床资料，根据血小板计数(PLT)是否<100×10⁹/L分为PLT减少组和PLT正常组，比较两组患者术中出血量、肝门阻断比例、肝门阻断时间、手术时间、术中输血量、术中是否放置引流管、术后并发症、住院时间等数据，探讨PLT水平对LLR出血量的影响和手术的安全性。 结果141例患者完成LLR，术中均未输注红细胞悬液，PLT减少组和PLT正常组的中位出血量分别为100 mL和50 mL，两组间差异无统计学意义(P＝0.111)，两组间肝门阻断比例、肝门阻断时间、手术时间和术中输血浆量均差异无统计学意义，PLT减少组放置引流管的比例明显高于PLT正常组(94.29%比78.50%，P＝0.040)；PLT减少组与PLT正常组术后并发症发生率差异无统计学意义(20.00%比10.28%，P＝0.149)；两组术后中位住院时间分别为7 d和6 d，差异无统计学意义(P＝0.062)。 结论通过仔细解剖、适当地肝门阻断和低中心静脉压技术，对合并血小板减少的肝细胞癌患者实施LLR是安全、可行的，经验丰富的腹腔镜肝脏外科医师还可以做到无输血LLR。

Efficacy and safety of laparoscopic liver resection for hepatocellular carcinoma with thrombocytopenia

ObjectiveTo investigate the effect of laparoscopic liver resection(LLR) on intraoperative bleeding in hepatocellular carcinoma (HCC) patients with thrombocytopenia. MethodsThe clinical data of 141 patients who underwent LLR for HCC in Department of General Surgery Center, Capital Medical University Affiliated Youan Hospital from Apr.2020 to Nov. 2022 were analyzed retrospectively. According to the level of PLT, they were divided into PLT reduced group and PLT normal group. The blood loss during operation, the proportion of hepatic portal occlusion, the time of hepatic portal occlusion, the time of operation, the amount of blood transfusion during operation, whether drainage tubes were placed during operation, the complications after operation, and the length of hospital stay were compared between the two groups, To investigate the effect of PLT level on the amount of bleeding and the safety of LLR. Results141 patients completed LLR without intraoperative infusion of red blood cells. The median bleeding volume of PLT reduced group and PLT normal group was 100 mL and 50 mL respectively. There was no statistical difference between the two groups (P=0.111). There was no statistical difference between the two groups in the time of hepatic portal occlusion, the operation time, the proportion of hepatic portal occlusion, and the amount of intraoperative plasma transfusion. The proportion of drainage tubes of PLT reduced group was significantly higher than that of PLT normal group (94.29% vs 78.50%, P=0.040) There was no statistical difference in the incidence of postoperative complications between the PLT reduced group and the PLT normal group (20.00% vs 10.28%, P=0.149). The hospital stay after surgery was 7 days and 6 days respectively and there was no difference between the two groups (P=0.062). ConclusionsLLR is safe and feasible for HCC patients with thrombocytopenia through careful anatomy, appropriate hepatic portal occlusion and low central venous pressure technology, and LLR without blood transfusion can also be performed by experienced hepatobiliary surgeon.