脾切除治疗成人特发性血小板减少性紫癜的临床观察

Clinical Observation of Splenectomy for treating Adult Idiopathic Thrombocytopenic Purpura

目的:研究脾切除对成人内科治疗无效的特发性血小板减少性紫癜(ITP的治疗效果.方法:对1990～2000年内科治疗无效的5例成人特发性血小板减少性紫癜患者进行脾切除手术.全组患者术后随访0.5～9年,平均46月.结果:术后血小板1周内恢复正常(≥100×10 9/L)者45例,占88.2%;术后2个月随访,总有效率90.2%.对41例患者进行中远期(0.5～9年)随访,总有效率为80.5%,4例复发,复发率9.75%.结论:术后血小板回升较早和回升幅度较高者预后较好.糖皮质激素治疗的效果不影响脾切除疗效.术前PAIgG检测值对预测脾切除疗效无相关性.选择性脾切除术对内科治疗无效的慢性ITP患者是一种安全和有效的治疗方法.

Objective:To investigate the effect of splenectomy for the patients with idiopathic thrombocytopenic purpuia(ITP) who failed to respond to conservative management. Method: Fifty-one cases with FTP treated by splenectomy during 1990 to 2000 were followed up from 6 months ~ 9 years (average 46 months).Results:Their platelet level recovered to normal during a week after operation in 45 cases (88.2% ) .The total effective rate was 90.2% after follow-up for 2 months and 80.5% in 41 cases after followed-up for mid-time and long time. The recurrence rate was 9.15% . Conclusion :The patients with increased platelet have a favourable prognosis. Corticosteroid treatment does not affect splenectomy treatment .There is no relationship between PAIgG and the patients clinical response to splenectomy. The splenectomy is a safe and effective therapy for the patients with ITP who failed to respond to conservative managenent.