免疫性血小板减少性紫癜(ITP)脾切术临床疗效探讨(1)
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【摘要】 目的 探讨不同类型免疫性血小板减少性紫癜经脾切术治疗后临床疗效,及腹腔镜下脾切除术的并发症。方法 将32例免疫性血小板减少性紫癜患者采用脾切除术治疗,然后按照脾切除疗效标准进行疗效评价。结果 32例免疫性血小板减少性紫癜患者采用脾切除术治疗后:总疗效较好15例46.9%、良好8例占25.0%、一般6例占18.8%、无效3例占9.4%。其中,激素无效型疗效较好与良好共8例占自身患者的80%,而激素依赖型疗效较好与良好共15例占自身患者的68.2%。结论 腹腔镜下脾切除术是治疗激素依赖型与激素无效型ITP的有效方法,具有手术并发症发生率低和手术风险小等优点。
【关键词】 免疫性血小板减少性紫癜(ITP);腹腔镜脾切术;临床疗效;并发症
Immune thrombocytopenic purpura (ITP) clinical effects of splenectomy surgery
WANG Gen-jie.
The blood branch first People’s Hospital Henan,Shangqiu 476100,China
【Abstract】 Objective To explore the different types of immune thrombocytopenic purpura after splenectomy in the treatment of clinical efficacy,and laparoscopic splenectomy complications. Methods 32 patients with immune thrombocytopenic purpura treated with splenectomy,and then follow splenectomy Evaluation of efficacy criteria.Results 32 patients with immune thrombocytopenic purpura treated by splenectomy after treatment: The total efficacy of 46.9% better in 15 cases,good in 8 cases accounted for 25.0%,accounting for 18.8% of the general 6 cases,3 cases accounted for 9.4%. Among them,hormone invalid type well and good efficacy accounted for a total of eight cases of their own 80% of patients,while the hormone-dependent efficacy well and good in 15 cases accounted for 68.2% of patients themselves.Conclusion Laparoscopic splenectomy is the treatment of steroid-dependent and hormone-based ITP invalid effective method,with a lower incidence of surgical complications and surgical risks of small-and so on.
【Key words】 Immune thrombocytopenic purpura (ITP); laparoscopic resection of the spleen; the clinical efficacy;Complications
免疫性血小板减少性紫癜(ITP)是自身免疫性疾病,对于内科激素严格治疗无效的病例采用脾切除术是较好的治疗方法[1]。腹腔镜脾切除术(LS),这种手术方式在治疗一些血液疾病方面得到了广泛应用。现对本院32例免疫性血小板减少性紫癜患者采用脾切除术治疗进行分析如下。
1 资料与方法
1.1 一般资料 本院免疫性血小板减少性紫癜患者32例,男13例,女19例,男女之比为1:1.46。年龄31～59岁,平均年龄为41.6岁。所有患者均符合ITP的诊断标准[2],其病史为1~5年之间,平均2.7年。
1.2 临床表现 32例免疫性血小板减少性紫癜患者血小板在(5～45)×109/L。所有患者脾脏体积正常或轻度脾大。其中伴有糖尿病患者3例,高血压患者4例,消化道溃疡1例。激素无效型10例,激素依赖型22例。
1.3 术前准备 术前静脉滴注地塞米松5～20 mg/d 或加用大剂量丙种球蛋白0.4 g/kg,共5 d,尽可能使血小板计数>30×109/L。所有患者手术开始前给予氢化可的松200 mg,同时术前1 d及手术开始各输血小板悬液10 U。
1.4 手术方法 手术采用全身麻醉,侧斜卧位或完全右侧卧位,头侧抬高20°～30°,采用3孔法行腹腔镜下脾切除术,脐向左侧水平线与左锁骨中线向下延长线的交点为腹腔镜观察孔,并在此处穿刺建立气腹,气腹压力12～15 mm Hg ......
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