选择性脾切除术治疗儿童ITP的疗效探讨

Effective and Safe Procedure for Children with Idiopathic Thrombocytopenic Purpura by Elective Splenectomy

目的探讨近年来儿童慢性特发性血小板减少性紫癜(ITP)患者行选择性脾切除术的有效性及安全性。方法收集1986年～2000年新华医院及上海儿童医学中心行选择性脾切除术治疗ITP的患儿资料,以术后血小板计数的稳定最低值判断疗效,回顾性研究其相关因素。结果16例慢性ITP患儿行选择性脾切除术,其中9例男孩,7例女孩。治愈7例(43.75%),好转5例(31.25%)。术后随访未有感染并发症发生。治愈患儿的术后血小板峰值均超过400×109/L,而其余患儿中仅2例超过400×109/L,经Fisher精确检验,两组间有显著差异(P<0.01)。结论选择性脾切除术是治疗儿童慢性ITP安全有效的方法。脾切除术后的疗效与术后血小板最高峰值相关,术后高的血小板计数峰值将提示着良好的预后。

Objective The aim of this study was to review the safety and efficacy of elective splenectomy in children with chronic idiopathic thrombocytopenic purpura(ITP).Methods The medical records of children with ITP treated with elective splenectomy were reviewed at XinHua hospital and Shanghai Children's Medical Center since1986.Results Sixteen evaluable patients who had ITP were identified by elective splenectomy .9were boys and7were girls.Age at diagnosis ranged from1to8years old(mean5.4years),and age at splenectomy ranged from3to13years old (mean7.6years).No patient died from the operation and no cases of postsplenectomy sepsis were found.At follow-up period from3months to6years(mean4.5years),7patients(43.75%)were cured,their platelet peak value exceed400x10 9 /L,i.e.reaching a normal platelet count,and5patients' platelet count increased20x10 9 /L than before.4patients platelet count had no remarkable change.Conclusions Elective splenectomy is a safe and effective procedure for children with chronic or refractory ITP.Efficacy of splenectomy is related to peak value of platelet after the operation,postoperation high peak value of platelet(count>400x10 9 /L)suggesting a good prognosis.