The Correlation Studies Between Postoperative Platelet Counts And Liver Failure、Liver Regeneration After Hemihepatectomy In Patients With Primary Hepatocellular Carcinoma

Objective:Through a retrospective analysis of the influence of platelet counts on liver failure and liver regeneration in patients with primary hepatocellular carcinoma（HCC）,it gives a treatment strategy for clinical prevention and treatment of postoperative liver failure and residualing liver regeneration.Method:The clinical data of 111 patients with primary hepatocellular carcinoma（HCC）having the background of hepatitis B infection who underwent semi-hepatectomy（extended semi-hepatectomy）from June 2012 to June 2017 in the First Affiliated Hospital of Guangxi Medical University were collected,which makes the corresponding statistical analysis.The grades of postoperative liver failure and complications were respectively judged by the ISGLS liver failure classification standard and Dino-Clavien classification standard.The two groups of patients were reviewed CT examination about 5days and 80 days after half liver resection,measuring postoperative residual liver volume by adopting IQQA liver 3D imaging system owned by the First Affiliated Hospital of Guangxi Medical University respectively,the average amount of hyperplasia of remaining liver volume was expressed as RLV_{80.4 day}-RLV,the average rate of hyperplasia was expressed as(RLV_{80.4 day}-RLV)/RLV×100%.Logistic regression model was used for univariate and multivariate analysis.Threshold value of platelet count was calculated by receiver operating characteristic curve（ROC）.Results:Based on ISGLS liver failure grading standards andDino-Clavien postoperative complication criteria,the incidence of grade B and above liver failure was 55%and complicationsⅡlevel and above was 47.5%in the platelet decline group after semi-hepatectomy,however,the incidence in normal group was 26.8%and 23.9%.there was statistically significant difference in the two groups（P₁=0.003,P₂=0.011）;The average volume of liver hyperplasia（RLV80.4 day-RLV）in the platelet decline and normal groups was132.09±81.89cm3 and 190.89±91.98cm3,and the average rate of hyperplasia（（RLV80.4 day-RLV）/RLV）was 16.59%±9.36%and 24.78%±12.82%.The difference between the two groups was statistically significant(P _{Proliferation}=0.001,P _{Proliferation rate}=0.001).Postoperative residual liver regeneration is closely related to the grade of liver failure occurrence,thus univariable and multivariable logistic regression analysis of postoperative liver failure grade and Proliferation rate in patients who underwent semi-hepatectomy,the results suggest that:Postoperative platelet counts down（OR=3.18（1.16,8.75）,P=0.025）,preoperative liver fibrosis or cirrhosis（Ishak score>4）（OR=2.85（1.04,1.04,P=1.04）,total bilirubin values increasing on the seventh day after resection（TB-POD7≥20.5 umol/L）（OR=5.71,1.68,19.46）,P=0.005）might be independent risk factors of severe PHLF（PHLF-class B OR above）for patients with primary hepatocellular carcinoma（HCC）after half liver resection;Decreasing in postoperative platelet count（PLT<125 x 109/L）（OR=2.83,1.06,7.56）,P=0.038)were also independent risk factors of reduence of residual liver regeneration rate for them.Though Further analysising the correlation of the platelet count and post-operational complications rank ROC curve,we find that 101.8 x 10⁹/L of platelet count is the critical value for patients suffering serious complications after the half liver resection（AUC:0.733,P=0.001,sensitivity78.7%,specificity 63.9%）.There was no death.Conclusions:Platelet counts may effect the incidences of severe PHLF（PHLF-B or above）and the regenerational rate of the residual liver in patients with primary hepatocellular carcinoma（HCC）after half liver resection.In addition,the patients with preoperative liver fibrosis or cirrhosis and high level of postoperative bilirubin would have more chance to occur PHLF-B or above.Therefore,（1）There is correlation between platelet count and postoperative PHLF or liver regeneration;（2）monitoring platelet counts after liver resection may help us to predict the suffering of PHLF-B or above and severe postoperative complications;（3）interposing platelet counts after liver resection in patients earlily could promote the regeneration of the residual liver.which provide a feasible strategy for preventing and reducing the incidence of postoperative severe liver failure,promoting the regenerational rate of the residual liver.