脾切除治疗原发性血小板减少性紫癜的临床观察  

Clinical observation of splenectomy on chronic idiopathic thrombocytopenic purpura in 63 patients

作　　者：朱继业[1] 冷希圣[1] 董南 王福顺[1] 黄磊 祝学光[1] 杜如昱[1] 

机构地区：[1]北京医科大学人民医院普外科

出　　处：《中华外科杂志》1998年第5期287-289,共3页Chinese Journal of Surgery

摘　　要：目的研究脾切除对原发性血小板减少性紫癜的治疗效果。方法对１９７４年～１９９６年内科治疗无效的６３例原发性血小板减少性紫瘢（ＩＴＰ）患者行脾切除手术并对其临床疗效进行观察。全组患者术后随访２个月至１６年，平均４．７年，其中随访半年以上者４８例。结果术前全部患者均有出血症状，血小板平均２４×１０９／Ｌ，术后１、３、５、７天血小板平均值分别上升为１１０×１０９／Ｌ、２０２×１０９／Ｌ、２５１×１０９／Ｌ和２４６×１０９／Ｌ，其中血小板一周内恢复正常（≥１００×１０９／Ｌ）者５１例，占８０．９％；术后２个月时血小板在正常范围者４５例，治愈率７３．８％，显效率１３．１％，总有效率为８６．９％。对３９例手术有效的病例长期随访，发现７例复发，复发率１７．９％。结论儿童组疗效略好于成人组，但差异无显著性意义；术前病程长短与手术疗效无相关关系；术后血小板回升较早及回升幅度较高者预后较好。Objectives To investrgate the effectirencess of splenectomy in patients with idiopathic thrombocytopenic purpura who failed to respond to conservative managment. Method Sixty three patients were treated with splenectomy and followed up for 2 months to 16 years (average 4 7 years). Result The patients had symptoms of bleeding and their platelet count on average was 24×10 9/L. The first, 3th, 5th and 7th day after operation, the average platelet count was 110×10 9/L, 202×10 9/L, 251×10 9/L and 246×10 9/L. Their platelet recovered to normal during a week in 51 cases (80 9%).The total effective rate was 86 9% after follow up for 2 months. The recurrence rate was 17 9% in 39 cases after follow up for longtime. Conclusions The curative effect of splenectomy is better in children than in adults. In patients with increased platelet have a favourable prognosis.Splenectomy is safe and effective in the treatment of idiopathic thrombocytopenic purpura.

关 键 词：紫癜 血小板减少性 特发性 脾切除术 

分 类 号：R554.605[医药卫生—血液循环系统疾病] R657.6[医药卫生—内科学]