丙肝抗病毒治疗前脾切除纠正血小板减少症

SPLENECTOMY FOR ANTIVIRAL THERAPY IN PATIENTS WITH HEPATITIS C CIRRHOSIS

目的应用脾脏切除术纠正血小板减少症,为慢性丙型肝炎抗病毒治疗提供条件。方法回顾性总结了我们收治的7例慢性丙型肝炎患者的临床资料。结果7例慢性丙型肝炎或肝硬化患者,肝功能均为ChildA级,行开腹病理性脾脏切除术,术中出血量为150～400ml左右,未输血,术后所有患者血小板均在1周内升至正常水平,无手术死亡或术后门静脉血栓形成。术后10至14天后均给予干扰素加利巴韦林抗病毒治疗24～48周。结论丙型肝炎肝硬化患者施行脾脏切除术是安全有效的,术后1周患者外周血血小板就显著上升,即可开始干扰素抗病毒治疗。该方法适用于慢性丙型肝炎准备行抗病毒治疗,因外周血白细胞、血小板减少而无法进行的患者。

Object To report 7 cases of spleuectomy to raise platelet counts so that pegylated interferon and ribavirin can be given in patients with hepatitis C cirrhosis. Methods Retrospective chart and computer record review. Results seven patients with hepatitis C cirrhosis had elective splenectomy for thrombocytopenia before pegylated interferon-a 2b therapy. All had thrombocytopenia contraindicating antiviral therapy. All were Child＇ s-Pugh Class A and had increases in platelet count at 14 days postsurgery. Median hospital stay and blood loss were 9 days and 228. 5 ml. There were no deaths or portal vein thrombosis. All had completed pegylated interferon-a 2b and ribavirin therapy. Conclusions Splenectomy in patients with hepatitis C cirrhosis can be done safely to allow application of antiviral treatment for those with thrombocytopenia.