特发性血小板减少性紫癜血小板参数的测定

随着血球分析仪的改进，本院自1998年开展了血小板平均体积(MPV)、血小板压积(PCT)及血小板分布宽度(PDW)等参数的测定，现将本院开展血小板参数测定至今71例特发性血小板减少性紫癜(ITP)患者和50例对照组的血小板计数(Pt)、MPV、PCT及PDW报告如下。     

特发性血小板减少性紫癜行腹腔镜脾切除术患者的护理

目的探讨经腹腔镜脾切除治疗特发性血小板减少性紫癜患者围术期的护理对策。方法对行腹腔镜脾切除术的8例患者做好术前心理护理，术前指导及充分准备；术后严密观察病情变化，并发症的观察及预防，做好出院指导。结果8例患者均顺利康复出院，随访2个月，无严重并发症发生。结论良好的围术期护理能减少腹腔镜脾切除术后出血等并发症，减轻患者的痛苦，对患者的恢复具有重要意义。     

脾切除治疗儿童特发性血小板减少性紫癜

目的 评估脾切除术治疗儿童特发性血小板减少性紫癜（ITP）的安全性和有效性。方法 回顾分析5年37例ITP患儿行选择性脾切除术的疗效术后早期并发症。结果 所有患儿在转入外科前均在内科接受正规治疗。32例（86.6%)患儿脾切除后效果显著,5例（13.4%)部分显效,术后并发症有3例,其中1例为严重感染。结论 选择性脾切除术是儿童ITP一种安全和有效的治疗手段。     

腹腔镜脾切除术治疗特发性血小板减少性紫癜

目的：探讨腹腔镜脾切除术治疗特发性血小板减少性紫癜的手术安全性、可行性和临床疗效。方法：回顾性分析35例内科治疗无效的特发性血小板减少性紫癜患者行腹腔镜脾切除术的临床资料。33例成功地完成腹腔镜脾切除术。另2例在腹腔镜脾切除后脾床渗血，施行小切口脾床止血。结果：手术时间70～180min，平均4120min。术中出血量20-600mL，平均120mL。平均住院时间6．4d，无并发症发生。术后随访3～20个月，平均lO个月，19例完全有效，12例部分有效，总有效率88．6％。结论：腹腔镜脾切除术治疗特发性血小板减少性紫癜安全可行、痛苦少、恢复快。     

脾切除术治疗特发性血小板减少性紫癜29例报告

目的探讨脾切除术治疗特发性血小板减少性紫癜（idiopathic thromboeytpertic purpura,ITP）手术以及围手术期处理需要注意的问题和疗效。方法回顾性分析29例ITP患者临床资料,包括年龄、性别、围手术期治疗等,对临床疗效进行观察。结果手术前10例患者行腹部CT检查,8例发现副脾,1例发现右侧肾肿瘤,1例发现腹膜后血肿,25例行腹部B超检查,5例发现副脾。29例均行脾切除术,手术中切除副脾8例。手术后1例颅内出血死亡,其余存活,死亡率3．45％。手术后胰尾小动脉出血1例,二次手术予以止血,1例并发左侧膈下脓肿。29例患者脾切除术后第一天有效率100％,手术后1周有效率93％（27／29）。随访15例,随访2～87个月,其中有效73．7％（11／15）,部分有效13．3％（2／15）,无效6．67％（1／15）。结论完善检查、围手术期处理措施得当是ITP外科手术治疗的关键因素。     

美罗华治疗难治性特发性血小板减少性紫癜的护理

目的探讨美罗华治疗难治性特发性血小板减少性紫癜的护理要点。方法对15例采用美罗华治疗的难治性特发性血小板减少性紫癜患者,采取注意规范药物配制、用药方法、控制输液速度、观察药物不良反应及骨髓抑制的护理等措施。结果 15例中5例未发生不良反应,10例发生不良反应,经观察与处理后均缓解。结论使用美罗华治疗时应严格掌握其使用方法、药物作用及不良反应,及时对症处理。     

特发性血小板减少性紫癜与幽门螺杆菌感染的相关研究

特发性血小板减少性紫癜(ITP)是一种自身免疫性疾病.其发病机制尚不完全清楚,部分患者可能与病毒及革兰氏阴性细菌感染有关,近年来许多研究表明根除幽门螺杆菌(HP)后部分ITP患者的血小板计数明显增多,并伴随血清血小板自身抗体(PAIgG)水平下降,提示HP可能是部分ITP的致病因子之一.本文对国内外文献进行综速有助于寻求可能导致ITP发病的新病因,以及深入探讨其发病机理.并可提出了非免疫治疗新方法.但是HP在ITP的发病意义仍有争论,这有赖于更深层次的分子生物学研究和更严格的流行病学调查来明确.     

美罗华治疗难治性特发性血小板减少性紫癜的护理

目的探讨美罗华治疗难治性特发性血小板减少性紫癜的护理要点。方法对15例采用美罗华治疗的难治性特发性血小板减少性紫癜患者,采取注意规范药物配制、用药方法、控制输液速度、观察药物不良反应及骨髓抑制的护理等措施。结果 15例中5例未发生不良反应,10例发生不良反应,经观察与处理后均缓解。结论使用美罗华治疗时应严格掌握其使用方法、药物作用及不良反应,及时对症处理。     

Emergency splenectomy for idiopathic thrombocytopenic purpura in children

Splenectomies were performed in 30 children out of a total of 183 with idiopathic thrombocytopenic purpura (ITP). Of these 30, ten splenectomies were performed on an emergency basis. Significant spontaneous gross hematuria, gastrointestinal bleeding or epistaxis appear to represent harbingers of intracranial hemorrhage and constitute indications for emergency splenectomy.     

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura

BACKGROUND: Laparoscopic splenectomy (LS) has become the treatment of choice for patients with idiopathic thrombocytopenic purpura (ITP) who do not respond to medical treatment. Long-term follow-up data of LS for ITP are scarce. METHODS: From May 1997 to December 2002, we performed 67 LS for patients with ITP. Data were assessed retrospectively. RESULTS: LS was successfully attempted in all 67 patients. There was no surgical mortality. Three postoperative complications (5%) were encountered. The mean operative time decreased significantly from 176.2 minutes in the first 41 cases to 125.2 minutes in the last 26 cases. The mean postoperative hospital stay was 3.2 days. Accessory spleens were found in 3 patients (5%) during the LS. The mean follow-up interval was 23.3 months. The initial response to LS was 83%, and overall remission of ITP was 74%. The preoperative effect of steroid therapy had no significant influence on postoperative remission rate. More significant indicators of LS effectiveness were either an immediate postoperative platelet count surge or an immediate postoperative platelet count >or=100000/microL. CONCLUSIONS: LS can be performed safely with a satisfactory remission rate for patients with ITP who do not respond to medical treatment. Our results indicated that an immediate postoperative platelet count surge and/or an immediate postoperative platelet count >or=100000/microL were positive predictors of long-term remission after LS for ITP.     

腹腔镜脾切除术治疗难治性特发性血小板减少性紫癜

目的探讨腹腔镜脾切除术(laparoscopic splenectomy,LS)治疗内科药物治疗无效的难治性特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)的可行性和疗效. 方法回顾性分析1999年9月～2004年7月31例难治性ITP(血小板计数<50×109/L)行LS的临床资料.采用全麻、右侧斜卧位或完全右侧卧位、三孔法(27例)或四孔法(4例)进行手术. 结果 2例中转传统开腹手术.29例完成LS,手术时间为65 ～325 min,平均137 min.术中出血量50 ～600 ml,平均116 ml.6例术中发现副脾并切除.术后2例切口感染,1例切口皮下血肿.术后随访3～41个月,平均11个月,16例(55.2%)完全显效,8例(27.6%)部分显效,总有效率82.8%(24/29). 结论 LS治疗难治性ITP安全可行,效果良好.     

肾移植治疗ITP合并慢性肾衰竭1例报告并文献复习

目的探讨肾移植治疗特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)合并慢性肾衰竭的围手术期处理及移植效果。方法对1例ITP合并慢性肾衰竭患者施行亲属活体肾移植术。术前予以静脉滴注免疫球蛋白及重组人血小板生成素冲击治疗,使其手术当日血小板升至170×109/L,术中未予脾切除,术后常规给予免疫抑制剂、防治感染、支持等治疗。结果受者手术顺利。移植后肾功能恢复正常,随访4年,血小板水平高于术前,凝血指标正常。结论对于ITP合并慢性肾衰竭的患者,行同种异体肾移植手术是安全有效的治疗方法,术中不必行脾切除,适当的术前准备是手术成功的关键。     

特发性血小板减少性紫癜脾切除术后早期并发症

目的 评估脾切除治疗特发性血小板减少性紫癜（ＩＴＰ）的安全性。方法 回顾分析了１６７例ＩＴＰ选择性脾切除术的术后早期并发症。结果 １４例（８．３８％）病人出现１７例次术后早期并发症;切口感染７例,腹腔大出血２例,颅内出血２例,膈下脓肿１例,肺感染１例,应激性高血糖反应４例。２例（１．２０％）术后并发颅内出血死亡。结论 选择性脾切除术是ＩＴＰ一种安全的治疗手段。     

Hematological long-term results of laparoscopic splenectomy for patients with idiopathic thrombocytopenic purpura: a case control study

Background Laparoscopic splenectomy (LS) for idiopathic thrombocytopenic purpura (ITP) appears, when compared to open splenectomy (OS), associated with immediate important advantages. However, in a number of patients splenectomy does not lead to an adequate response, or after initial adequate response a relapse occurs after some time. A relapse may be associated to the presence of accessory spleens and splenosis. The purpose of this study was to compare the operative outcome and the hematological results on the long term of a series of LS with a historic series of OS for the treatment of ITP.Methods A retrospective review was done of 50 consecutive patients who underwent LS for ITP. Patient characteristics, outcome of surgery, and hematological results were compared to a historical group of patients who underwent conventional splenectomy for ITP (n = 31). Response to splenectomy was defined in three groups: complete remission, partial remission, and no response. Grouping was based on hematological data.Results Concerning operative outcome and postoperative complications, there was a significant difference in favor of LS. Moreover, the hematological outcome of both groups showed no differences after a median period of 66 months (OS) and 35 months (LS), respectively.Conclusions Hematological results after laparoscopic splenectomy for ITP are comparable to those after open splenectomy in both the short and the long term.     

Splenectomy versus medical treatment for idiopathic thrombocytopenic purpura

BACKGROUND: Treatment strategies for idiopathic thrombocytopenic purpura (ITP) are still uncertain and its management is primarily empirical. The aim of this study was to investigate the role of splenectomy in the therapy of ITP and to evaluate whether medical or surgical treatment is superior. METHODS: Ninety-two patients with ITP were included in the study. All of these patients had medical therapy and 38 of them underwent splenectomy subsequently. Follow-up was completed in 91 patients after a median of 64 months. RESULTS: Side effects of medical therapy were noticed in 32 patients (35%), whereas after surgery only 2 patients (5%) had minor complications. A complete or partial remission was achieved in 35 patients (92%) after splenectomy, whereas this was achieved in only 27 patients (30%) after medical therapy. On multivariate analysis splenectomy and age were the only significant independent factors for complete and partial remission. CONCLUSIONS: Splenectomy is highly effective and safe in the treatment of ITP and is superior over medical therapy. These results should stimulate the discussion about splenectomy for ITP, possibly establishing evidence-based guidelines for surgical treatment in hematology.     

慢性特发性血小板减少性紫癜与心内直视术

合并慢性特发性血小板减少性紫癜(ITP)的心脏病患者，接受体外循环(CPB)心内直视术后，会面临较大的出血风险。通过术前应用激素、大剂量静脉注射γ-球蛋白、达那唑，术前或同期行脾切除术，术中应用膜式氧合器、抑肽酶和／或止血环酸、肝素涂敷CPB管道、离心泵、自体血液回收、常温以及CPB结束后输注血小板等综合措施，术后可明显降低此类患者的出血风险。     

Laparoscopic splenectomy reduces the need for platelet transfusion in patients with idiopathic thrombocytopenic purpura.

OBJECTIVES: Laparoscopic splenectomy has been increasingly used in patients with idiopathic thrombocytopenic purpura. Because it is associated with minimal abdominal trauma, platelet consumption could be reduced with the laparoscopic approach. The aim of this study was to analyze intraoperative bleeding and the need for apheresis platelets, comparing laparoscopic with open splenectomy. METHODS: Records of 40 patients who underwent splenectomy (20 through laparoscopy and 20 through open surgery) for idiopathic thrombocytopenic purpura were retrospectively reviewed. Intraoperative bleeding and need of perioperative apheresis platelets were evaluated in both groups. Statistical evaluation was conducted using the Mann-Whitney rank test, and differences were considered significant at P<0.01. RESULTS: The mean amount of intraoperative bleeding was less in the laparoscopic group (P<0.01). Apheresis platelets were necessary in all patients in the open group (2 units transfused in 55% and 1 unit in 45% of cases) and only in 30% of cases in the laparoscopic group (1 unit transfused in each case). CONCLUSIONS: Laparoscopic splenectomy is a safe procedure also in patients at high risk for bleeding diathesis. In idiopathic thrombocytopenic purpura, laparoscopic splenectomy should be the gold-standard surgical treatment. Need of platelet transfusion is probably reduced when laparoscopic splenectomy is compared with open surgery in these patients.     

腹腔镜下脾切除术治疗特发性血小板减少性紫癜的临床应用研究(附15例报告)

目的:探讨腹腔镜下脾切除术的手术方法和治疗特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)的临床效果。方法:选择15例ITP患者在腹腔镜下完成脾切除术,比较手术前后的血小板计数。结果:15例均在腹腔镜下完成脾切除术,平均手术时间160min,术中平均失血50ml,术后平均住院8d,总有效率为94%。术后1周内血小板的反应率为100%。无死亡、出血等严重并发症发生。结论:ITP患者行腹腔镜脾切除术是安全可行的,手术效果满意。