脾切除治疗74例成人原发免疫性血小板减少症的长期随访观察  

Long-term outcome of splenectomy for 74adult patients with immune thrombocytopenia

作　　者：刘晓帆[1] 孙朝侠[1] 王志军 陈云飞[1] 黄月婷[1] 刘葳[1] 薛峰[1] 张磊[1] 徐茂强 杨仁池[1] 

机构地区：[1]中国医学科学院,北京协和医学院血液学研究所血液病医院,天津300020

出　　处：《临床血液学杂志》2015年第5期769-773,共5页Journal of Clinical Hematology

基　　金：国家自然科学基金(No:81270581;81300385;81470286);天津市应用基础及前沿技术研究计划重点项目(No:14JCZDJC35100)

摘　　要：目的:探讨脾切除治疗成人原发免疫性血小板减少症(ITP)的长期疗效和安全性。方法:回顾性分析74例诊断为ITP后接受脾切除治疗并获得长期随访资料的患者,观察脾切除的近期有效率和手术并发症。长期随访(≥12个月)血小板的持续反应率,脾切除的远期并发症,病死率与患病率。预测脾切除前常见的临床指标对切脾疗效的影响。结果:脾切除的即刻总反应率为95.9%(71/74)。手术并发症包括切口感染2例(2.7%),上呼吸道感染1例(1.4%),切口脂肪液化1例(1.4%);未发生血栓并发症。脾切除后血小板反应性增高患者3例(4.1%)。术后随访1年、3年、5年的持续反应率分别为86.5%,86.1%,77.2%。随访期间共有27例(36.5%)患者复发。远期患病率为2.7%,包括急性阑尾炎1例,双臂软组织感染1例。病死率为4.1%,因血小板减少导致脑出血死亡2例,泌尿系出血死亡1例。脾切除疗效的预测因素显示,年轻(≤40岁),对丙种球蛋白治疗有效患者,脾切除治疗可获得较好的治疗反应(P<0.05)。结论:脾切除治疗成人原发ITP能够维持长期疗效,病死率与患病率均较低。对于年轻患者以及丙种球蛋白治疗有效的患者,脾切除后可获得较好的治疗反应。Objective：To explore the tong term efficacy and safety of splenectomy for immune thrombocytopenia （ITP）. Method：The data of 74 ITP patients who underwent splenectomy were retrospectively analyzed,including the immediate response rate and surgical complications, the long-term sustained response rate, the long-term complications, and the overall post-splenectomy mortality and morbidity. Demographic, clinical and laboratory variables were studied for their ability to predict response to splenectomy. Result： The post-splenectomy immediate response rate was 95.9 % （71/74）. Surgical complications included two cases （2.7 % ） with incision infection, one case （1.4 % ） of upper respiratory tract infection, and one case （1.4 %） with fat liquefaction of incision,without venous thromboembolism. There were three cases （4. 1%） of persistent thrombocytosis post-splenectomy. The sustained response rates were 86. 5%, 86. 1 % and 77.2% respectively following-up for the first year, third year and fifth year. Twenty seven patients （36. 5%） relapsed during follow-up. The overall morbidity was 2. 7%, one patient （1.4 0%） experienced acute appendicitis and one patient （1.4 %） experienced arm soft tissue infection. The overall mortality was 4.1%, two cases died of cerebral hemorrhage and one died of urinary tract hemorrhage. Preoperative characteristics including younger age and patients who respond to intravenous immune globulin （IVIG） therapy, consistently predicted response to splenectomy （P〈0.05）. Conclusion： Splenectomy provides a high frequency of durable responses for adult patients with ITP,and associates with lower morbidity and mortality. Younger age and responsing to IVIG are associated with a more favorable response to splenectomy.

关 键 词：免疫性血小板减少症 脾切除 持续反应 

分 类 号：R558.2[医药卫生—血液循环系统疾病]