目的 探讨氩氦刀冷冻消融术治疗中晚期原发性肝癌患者的血小板计数变化规律.方法 选取2013年7月-2016年6月湖南中医药大学第一附属医院收治的中晚期原发性肝癌患者60例,均行氩氦刀冷冻消融术(术前血小板计数≥50×10.9/L)治疗,冷冻针布针1~3根者为A组,4~10根者为B组,11~15根者为C组.总结A组、B组、C组术前、术后血小板计数变化规律.结果 A组术前和术后3、7、14 d的血小板计数比较,差异无统计学意义(P>0.05);B组、C组术前和术后3、7、14 d的血小板计数比较,差异有统计学意义(P<0.05);B组、C组术后3 d与术前血小板计数比较,差异有统计学意义(P<0.01).由于A组术前和术后血小板计数变化不明显,故仅对B组、C组患者按术前血小板计数再次分组,术前血小板计数≥50×10.9/L且<100×10.9/L定义为观察组,血小板计数≥100×10.9/L定义为对照组.对照组和观察组术前和术后3、7、14 d的血小板计数组内比较,差异有统计学意义(P<0.05);对照组、观察组术后3 d与术前血小板计数比较,差异有统计学意义(P<0.01).结论 氩氦刀冷冻消融术治疗中晚期原发性肝癌,血小板计数≥50×10.9/L、冷冻针≤3根时血小板计数没有明显变化,4~15根时血小板计数表现为术后3 d下降到氩氦刀冷冻消融术前的50%左右,而术后7 d回升至术前水平,术后14 d保持稳定.%Objective To explore the platelet count change rule of medium-advanced primary hepatic carcinoma treated by argon-helium cryosurgery.Methods Sixty cases with medium-advanced primary hepatic carcinoma admitted in the First Hospital of Hunan University of Chinese Medicine from July 2013 to June 2016 were selected as the participants.All of them had preoperative platelet count equal to or greater than 50×10.9/L,and received argon-helium cryosurgery.Based on the number of cryoneedles used in the surgery,they were divided into group A(using 1-3 cryoneedles),group B(using 4-10 cryoneedles),group C(using 11-15 cryoneedles).The postoperative platelet count change rules in groups A,B and C were summarized.Results Platelet count measured before the surgery,at 3,7,14 d after the surgery differed significantly in groups B and C(P<0.05),but not in group A(P>0.05).Platelet count measured before the surgery was obviously different from that measured at 3 d after the surgery in both groups B and C(P<0.01).As the change of platelet count was obvious in groups B and C,so we further studied the change of it in them.Patients with platelet count level lower than 100×10.9/L but equal to or greater than 50×10.9/L and those with it equal to or greater than 100×10.9/L in group B and group C were assigned to the observation group and control group,respectively.Platelet count measured before the surgery,at 3,7,14 d after the surgery differed significantly in both the observation group and control group (P<0.05).Significant differences were found between the platelet count measured before the surgery and that measured at 3 d after the surgery in both the observation group and control group (P<0.01).Conclusion During the perioperative period of argon-helium cryosurgery for medium-advanced primary hepatic carcinoma patients whose preoperative platelet count levels were equal to or greater than 50×10.9/L,platelet count did not change significantly in those used 1-3 cryoneedles,but in those used 4~15 cryoneedles,it dropped by almost half of the preoperative level at the 3rd day after surgery,then elevated to the preoperative level at the 7th day after surgery,and remained stable at the 14th day after surgery.
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