血小板低于1×10^9／L的血小板减少性紫癜患者脾切除术疗效及影响因素  

Clinical outcomes and impact of splenectomy in ITP patients with PLT 〈 1 ×10^9/L

作　　者：李扬 李灏[2] 王磊[1] 李峰[1] 刘晗[1] 杨洲[1] 陈伟[1] 

机构地区：[1]山东大学齐鲁医院普外科,济南250012 [2]山东大学齐鲁医院血液科,济南250012

出　　处：《中华肝胆外科杂志》2016年第4期262-264,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨血小板（PLT）低于1×10^9／L的血小板减少性紫癜（ITP）患者行脾切除术后的疗效及相关影响因素。方法回顾性分析2007-2015年收治的13例PLT〈1×10^9／L的ITP患者临床资料，其中6例行腹腔镜睥切除术，7例行开腹脾切除术。根据手术指标及血液学指标分析脾切除的疗效及其相关影响闵素。结果13例手术均获得成功。平均手术时间为（185．0±31．8）min，平均术中出血量为（170．4±22．3）ml。术后4例患者出现刀口出血及皮下积液，2例出现腹腔积液，无颅脑出血等其他并发症发生。术后平均住院时间为（8．8±1．7）d，出院时患者平均PLT数量为（60．7±31．2）×10^9／L。术后第3、6和12个月随访显示有效率为46．2％，平均血小板数量约为（140．0±80．5）×10^9／L。结论脾切除术用于治疗PLT〈1×10^9／L的ITP患者是安全、可行、有效的。经常规内科治疗无效的患者应及早考虑手术治疗。Objective To investigate the efficacy of splenectomy in patients with immune thrombo- cytopenic purpura （ITP） and to study the relating impact factors. Methods The database of 13 patients with ITP with preoperative platelet counts of less than 1 ×10^9/L who underwent splenectomy in our center from 2007 to 2015 were retrospectively analyzed. Seven patients underwent open spleneetomy, and 6 patients laparoseopie splenectomy. The surgical and hematological outcomes and the relating impact factors were ana- lyzed. Results The 13 operations were all successfully earried out. The mean operation time was （185.0 ~ 31.8 ）min, and the mean intraoperative blood loss was （170.4 ± 22. 3 ）ml. There were no complications, e. g. cerebral hemorrhage except in 4 patients who developed bleeding, and 2 patients abdominal fluid collec- tions. The mean postoperative hospital stay was （8.8 ± 1.7）d, and the mean preoperative platelet eount was （60. 7 ±31.2） ×10^9/L. All the patients were followed-up for 3, 6 and 12 months after the operation. The efficacy rate was 46. 2% , and the mean postoperative platelet count were （ 140. 0 ± 80. 5 ） ×10^9/L. Conclusions Spleneetomy was feasible and efficacious for patients with ITP with PLT 〈 1 ×10^9/L. Sple- neetomy is recommended when medications are ineffective.

关 键 词：脾切除 腹腔镜 血小板减少性紫癜 极低血小板数量 疗效 影响因素 

分 类 号：R657.6[医药卫生—外科学]