Clinical analysis of ultrasound-guided laparoscopic microwave ablation in the treatment of early HCC with severe thrombocytopenia

Background Patients with hepatocellular carcinoma (HCC) frequently present with cirrhosis accompanied by thrombocytopenia, and severe thrombocytopenia (STP) represents a major therapeutic challenge in this population. The present study was designed to evaluate the safety and efficacy of ultrasound-guided laparoscopic microwave ablation for the management of early HCC with STP. Methods Clinical data from patients with early HCC who underwent ultrasound-guided laparoscopic microwave ablation at the Department of General Surgery I, Sixth People's Hospital of Shenyang between February 2023 and February 2024 were retrospectively analyzed. Patients were categorized into a study group (PLT < 50 × 10 9 /L) and a control group (PLT > 150 × 10 9 /L). Follow-up was continued until February 1, 2025, and postoperative recovery outcomes and disease-free survival were compared between groups. Propensity score matching (PSM) was applied to minimize baseline bias. A total of 49 patients with STP were included in the study group, while 48 patients with normal platelet counts were included in the control group. After 1:1 PSM, 22 patients were retained in each group. Results The study group exhibited greater intraoperative blood loss than the control group both before and after matching. However, no statistically significant differences were observed between the two groups with respect to operative duration, length of postoperative hospitalization, incidence of complications, or disease-free survival. Conclusion Ultrasound-guided laparoscopic microwave ablation is a safe and feasible therapeutic option for patients with early HCC and STP, demonstrating favorable short-term outcomes.