Research of Changes of Platelet Count after Splenectomy in Patients with Splenic Rupture or Cirrhosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHOU Junjing , GUO Zijian , DAI Saimin , GUO Jiangong , ZHOU Peng , ZHANG Yong

Department of Hepatobiliary Surgery， The Fourth Affiliated Hospital， Suzhou University， Wuxi 214062， Jiangsu Province， China;

Corresponding author：

Keywords：

Platelet; Splenic rupture; Cirrhosis; Splenectomy

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Objective 　To compare the difference of the changes of platelet counts after splenectomy between the patients with splenic rupture and patients with cirrhosis and portal hypertension, and to analyze the possible reasons and clinical significance.
Methods 　The platelet count of 47 splenic rupture patients and 36 cirrhosis patients who had been carried out splenectomy from July 2008 to December 2009 in our hospital were counted, and the differences in platelet count and it’s change tendency of two groups were compared.
Results 　In the splenic rupture group，the platelet count of all 47 patients increased abnormally after operation, the maxlmum value of platelet count among 300×109/L-600×109/L in 6 cases，600×109/L-900×109/L in 21 cases，and above 900×109/L in 20 cases. In the cirrhosis group，the maxlmum value of platelet count after operation was above 300×109/L in 26 cases，100×109/L-300×109/L in 8 cases，and below 100×109/L in 2 cases. The difference of maxlmum value of platelet count in the two groups had statistic significance（P=0.00）. Compared with the cirrhosis group, the platelet count increased more significant and decreased more slow in splenic rupture group（P＜0.05）.The abnormal days and rising range of platelet count were higher in patient with Child A than Child B and C（P=0.006，P=0.002）.
Conclusions 　The change of platelet count after operation in splenic rupture group was obviously different from cirrhosis group because of the difference of the liver function and body situation of patients. To patients with splenic rupture or cirrhosis, appropriate treatment based on the platelet count and liver function could obtain good therapeutic effect.

Citation： ZHOU Junjing,GUO Zijian,DAI Saimin,GUO Jiangong,ZHOU Peng,ZHANG Yong,.. Research of Changes of Platelet Count after Splenectomy in Patients with Splenic Rupture or Cirrhosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(4): 396-400. doi: Copy

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26.	杨志勇，余明主，郑智华. 无原发病外伤性脾切除患者术后血小板变化的研究 [J]. 实用中西医结合临床，2009，9(2)：5-7.

1. 夏穗生. 疑难普外科学 [M]. 武汉：湖北科学技术出版社，2001：564．.
2. Fukushima-Shintani M， Suzuki K， Iwatsuki Y， et al. AKR-501 (YM477) in combination with thrombopoietin enhances human megakaryocytopoiesis [J]. Exp Hematol， 2008， 36(10)： 1337-1342.
3. Erickson-Miller CL， Delorme E， Tian SS， et al. Preclinical activity of eltrombopag (SB-497115), an oral, nonpeptide thrombopoietin receptor agonist [J]. Stem Cells， 2009， 27(2)： 424-430.
4. Qian S， Fu F， Li W， et al. Primary role of the liver in thrombopoietin production shown by tissue-specific knockout [J].Blood， 1998， 92(6)： 2189-2191.
5. Osada M， Komeno T， Todokoro K， et al. Immature megakaryocytes undergo apoptosis in the absence of thrombopoietin [J].Exp Hematol， 1999， 27(1)： 131-138.
6. de Sauvage FJ， Carver-Moore K， Luoh SM， et al. Physiological regulation of early and late stages of megakaryocytopoiesis by thrombopoietin [J]. J Exp Med， 1996， 183(2)： 651-656.
7. Okubo M， Shiota G， Kawasaki H. Thrombopoietin levels in serum and liver tissue in patients with chronic viral hepatitis and hepatocellular carcinoma [J]. Clin Sci (Lond)， 2000， 99(3)：207-214.
8. Aref S， Mabed M， Selim T， et al. Thrombopoietin (TPO) levels in hepatic patients with thrombocytopenia [J]. Hematology，2004， 9(5-6)： 351-356.
9. Español I， Hernández A， Muñiz-Diaz E， et al. Usefulness of thrombopoietin in the diagnosis of peripheral thrombocytopenias [J]. Haematologica， 1999， 84(7)： 608-613.
10. Kujovich JL. Hemostatic defects in end stage liver disease [J].Crit Care Clin， 2005， 21(3)： 563-587.
11. 李琴，孙桂珍，王宝恩，等. 肝硬化患者外周血血小板生成素及脾脏指数间的关系 [J]. 中华肝脏病杂志， 2004， 12(4)：210-212.
12. El Barbary MA， Saad AE， Attia FM， et al. Thrombocytopenia in patients with chronic hepatitis C： a possible role of HCV on platelet progenitor cell maturation [J]. Angiology， 2010， 61(3)：304-313.
13. Sekiguchi T， Nagamine T， Takagi H， et al. Autoimmune thrombocytopenia in response to splenectomy in cirrhotic patients with accompanying hepatitis C [J]. World J Gastroenterol， 2006，12(8)： 1205-1210.
14. 徐希岳，王启之，吴炎，等. 肝硬变患者骨髓特征的临床观察 [J]. 临床荟萃， 2000， 15(4)：153．.
15. 王丽萍，刘战丛，史永涛. 脾切除贲门周围血管离断术后门静脉血栓形成的危险因素分析 [J]. 医学信息( 内外科版)，2009， 22(5)：406-407．.
16. 姜德清，黄继超. 脾切除加断流术后门静脉血栓形成36 例治疗分析 [J]. 临床外科杂志， 2004，12(11)：714-715．.
17. 姜国俊，金延方. 脾切除术后血小板增多症对血栓形成的影响——附 60 例报告 [J]. 新医学， 2007， 38(11)：733-735．.
18. Winslow ER， Brunt LM， Drebin JA， et al. Portal vein thrombosis after splenectomy [J]. Am J Surg， 2002， 184(6)： 631-635.
19. 王峰，张杰，高阳，等. 脾切除后门脉系血栓形成 32 例临床分析 [J]. 西南军医， 2010， 12(5)：877-878.
20. 付伟，金松，郑春梅，等. 脾破裂术后深静脉血栓形成的危险因素分析及预防对策 [J]. 黑龙江医药科学，2004，27(3)：80-80．.
21. Cordera F， Long KH， Nagorney DM， et al. Open versus laparoscopic splenectomy for idiopathic thrombocytopenic purpura： clinical and economic analysis [J]. Surgery， 2003， 134(1)： 45-52.
22. 赵海峰，佟立权，于海英，等. 腹腔镜脾切除术在外伤性脾破裂中的应用体会 [J]. 中国普外基础与临床杂志， 2011， 18(3)：313-316．.
23. 李永双，金俊哲，梁健，等. 手助腹腔镜脾切除加门奇静脉断流术对机体应激反应的影响 [J]. 中国普外基础与临床杂志，2008，15(12)：873-876．.
24. Pietrabissa A， Moretto C， Antonelli G， et al. Thrombosis in the portal venous system after elective laparoscopic splenectomy [J].Surg Endosc， 2004， 18(7)： 1140-1143.
25. Ikeda M， Sekimoto M， Takiguchi S， et al. High incidence of thrombosis of the portal venous system after laparoscopic splenectomy：a prospective study with contrast-enhanced CT scan [J].Ann Surg， 2005， 241(2)： 208-216.
26. 杨志勇，余明主，郑智华. 无原发病外伤性脾切除患者术后血小板变化的研究 [J]. 实用中西医结合临床，2009，9(2)：5-7.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research of Changes of Platelet Count after Splenectomy in Patients with Splenic Rupture or Cirrhosis

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