脾切除术在自身免疫性血液系统疾病治疗中的价值

Value of splenectomy in treating autoimmune hematological diseases

目的探讨脾切除术治疗自身免疫性血液系统疾病的应用价值。方法回顾性分析2003年1月至2018年1月于北京大学人民医院行脾切除术的85例自身免疫性血液系统疾病患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男26例,女59例;年龄18~71岁,中位年龄39岁。原发性免疫性血小板减少症(ITP)69例,自身免疫性溶血性贫血(AHA)12例,Evans综合征4例。患者均经过糖皮质激素或丙种球蛋白等一线治疗无效或激素不耐受或复发。根据手术方法不同将患者分为开腹脾切除术组(开腹组,55例)和腹腔镜脾切除术组(腔镜组,30例)。术后定期复查血常规,密切观察术后并发症情况和疗效。两组住院时间比较采用非配对t检验,率的比较采用χ2检验。结果腔镜组并发症发生率13%(4/30),开腹组18%(10/55),差异无统计学意义(χ^2=0.76,P>0.05)。腔镜组平均住院时间为(5.3±0.7)d,明显短于开腹组的(7.0±1.6)d(t=-2.87,P<0.05)。ITP患者术后1、5年完全缓解率为78%(54/69)、61%(42/69),AHA患者相应为83%(10/12)、58%(7/12),Evans患者相应为4/4、2/4。结论脾切除术仍是自身免疫性血液系统疾病可靠和效果良好的二线治疗方案,腹腔镜脾切除术与开腹脾切除术同样安全、有效,但具有微创、恢复快优势。

Objective To investigate the application value of splenectomy in the treatment of autoimmune hematological diseases.Methods Clinical data of 85 patients with autoimmune hematological diseases who underwent splenectomy in Peking University People's Hospital from January 2003 to January 2018 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,26 patients were male and 59 female,aged 18-71 years with a median age of 39 years.69 patients were diagnosed with primary immune thrombocytopenia(ITP),12 with autoimmune hemolytic anemia(AHA)and 4 with Evans syndrome.The first-line treatment of glucocorticoid or gamma globulin in some patients failed,and some were hormone intolerant or disease recurred.The patients were divided into the open splenectomy group(n=55)and laparoscopic splenectomy group(n=30)according to different surgical procedure.Routine blood tests were conducted after operation at regular intervals.Postoperative complications and clinical efficacy were closely observed.The length of hospital stay was statistically compared between two groups by unpaired t test.The rate comparison was performed by Chi-square test.Results The incidence of postoperative complications in the laparoscopic splenectomy group was 13%(4/30),where no significant difference was observed from 18%(10/55)in the open splenectomy group(χ^2=0.76,P>0.05).In the laparoscopic splenectomy group,the average length of hospital stay was (5.3±0.7) d, significantly shorter than (7.0±1.6) d in the open splenectomy group (t=-2.87,P<0.05). The 1- and 5-year complete remission rates were 78%(54/69) and 61%(42/69) for ITP patients,83%(10/12) and 58%(7/12) for AHA patients, and 4/4 and 2/4 for Evans syndrome patients, respectively.Conclusions Splenectomy is a reliable and effective second-line treatment for autoimmune hematologicaldiseases. Laparoscopic splenectomy is as safe and effective as open splenectomy, whereas it is minimallyinvasive and accelerates the postoperative recovery.