特发性血小板减少性紫癜的治疗策略

特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)是一组免疫介导的血小板过度破坏所致的出血性疾病。以广泛皮肤黏膜及内脏出血、血小板减少、骨髓巨核细胞发育成熟障碍、血小板生存时间缩短及血小板膜糖蛋白特异性抗体出现为特征的一种自身免疫性疾病。其发病机制:一是通过细胞介导的免疫调节形成并持续产生抗血小板的自身抗体;二是通过网状内皮系统加速破坏血小板。发病率约为5～10/10万人口,65岁以上老年人发病率有升高趋势。临床可分为急性型和慢性型,前者好发于儿童,后者多见于成人,本病多见于女性,用皮质激素和(或)脾切除等常规治疗完全缓解率可达60%～70%,如经足量皮质激素和(或)脾切除无效者称为难治性ITP(RITP)。常用治疗方法归纳如下。

脾脏外伤35例的临床疗效分析

目的:对脾脏外伤保脾治疗和切脾治疗的方法进行探讨。方法:遵循保命第一,保脾第二,切脾第三的治疗原则,根据患者的伤情,对35例患者分别选择保脾治疗或切脾治疗。结果:35例患者中,有8例采取保脾治疗,27例采取切脾治疗,全部病例获得了良好的疗效,临床观察效果好,无死亡病例。结论:遵循该切则切、该保则保的原则,对不同伤情的患者分别选择保脾治疗或切脾治疗的方式,具有安全性、可行性和有益性,值得临床推广。

RESECTION OF THE BODY AND TAIL OF THE PANCREAS WITH PRESERVATION OF SPLEEN

A total of 19 cases were performed the resection of the body and tail of the pancreas with preservation of spleen in our department since it was first successfully carried out in the late 1980′s The indications of operation were pancreatic cystadenoma(n=8),pseudocyst(n=2),insulioma(n=3),pancreatic injury(n=6) All but one went well intraoperatively and postoperatively with the normal appearance and function of the spleen The main observation items of postoperation were leukocyte phagocytosis test, splenic CT scan,ultrasonography and Technetium 99m spleen scan The exceptional one showed transient insufficiency of splenic blood supply after the operation Considering the regional conditions in the operations, the procedure could be classified into the resection of the body and tail of pancreas with and without conservation of the splenic artery and vein