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。     

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。     

脾切除治疗特发性血小板减少性紫癜202例

目的评价特发性血小板减少性紫癜脾切除治疗的远期疗效 ,探讨围手术期的特殊处理。方法对 1 974年 1月至 2 0 0 1年 6月脾切除治疗特发性血小板减少性紫癜 2 0 2例的临床资料进行回顾性分析 ,依临床症状改善情况分为有效组和无效组。结果术后并发症 1 8例 (8 9% ) ,远期随访 1 89例 ,有效组 1 5 9例 ,(其中显效 96例 ,良好 6 3例 ) ,无效组 30例 ,远期死亡 6例 (3 2 % )。术后血小板上升速度 1周内≥ 1 0 0× 1 0 9/L者共 1 1 8例 ,有效组 1 1 0例 ,占有效组 6 9 2 % ,无效组 8例 ,占无效组 2 6 7% (χ2 =1 9 4 5 ,P <0 0 1 ) ;术后血小板上升峰值≥ 2 0 0× 1 0 9/L者 5 6例 ,有效组 5 4例 ,占有效组 34 0 % ,无效组 2例 ,占无效组 6 7% (χ2 =9 0 3,P <0 0 1 )。脾脏病理定量检查与术后远期疗效相关。结论　术后 1周内血小板≥ 1 0 0× 1 0 9/L或血小板峰值≥ 2 0 0× 1 0 9/L者均预示脾切除远期疗效良好     

腹腔镜脾切除术治疗特发性血小板减少性紫癜

由于特发性血小板减少性紫癜(ITP)是血液病行脾切除最常见的指征。腹腔镜脾脏切除术(LS)术后胃肠功能恢复快，疼痛轻，并发症少，因此适用于ITP需行脾切除者。我们从2001年7月至2002年8月为16例ITP的患者行LS治疗，均取得成功。     

开腹脾切除术后血小板计数与血栓-栓塞性并发症关系探讨

我院 1 985年～ 2 0 0 0年开腹单纯行脾切除术共 395例 ,发生血栓 栓塞性并发症 3例 ,现报告如下。临床资料　　 1 .一般资料　　本组共 395例 ,男 32 8例 ,女 67例 ,年龄 6～ 78岁 ,平均 38岁。其中小儿 8例 ,均为血液病 ,占 2 %。外伤性脾破裂 2 86例 ,占 72 .4% ,肝硬化脾功能亢进 1 0 1例 ,占 2 5 .6 %。发生血栓 栓塞性并发症 (以下简称并发症 )各 1例。　　 2 .方法　　本组病例均在气管插管全麻下行开腹单纯脾切除术 ,术前、术中、术后均未输血小板 ,术前、术后每天测定血小板数值 1次 ,连续 7ｄ(见表 1 ) ,术后未输血液制品及未作预…     

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.     

腹腔镜脾切除术治疗血小板减少性紫癜近期血小板参数变化

对于药物治疗效果不佳或因复发不能耐受激素治疗的特发性血小板减少性紫癜(ITP)病人,脾脏切除术是治疗该病较有效的方法之一[1]。腹腔镜下脾脏切除术(LS)具创伤小、术后胃肠功能恢复快、疼痛轻、并发症少等优点,是ITP病人安全、经济的治疗选择[2]。目前对ITP病人采用LS术后的疗     

术前血小板计数与腹腔镜脾切除术治疗特发性血小板减少性紫癜疗效的关系

目的探讨术前血小板计数与腹腔镜脾切除术（LS）治疗特发性血小板减少性紫癜（ITP）疗效的关系。方法回顾性分析98例有随访资料、经LS治疗ITP患者的临床资料,根据术前1d血小板（PLT）计数分为3组：Ⅰ组PLT计数〈50×10^9／L,Ⅱ组PLT计数在（50～100）×10^9／L,BI组PLT计数〉100×10^9／L。比较：,组间的手术结果指标及长期血液学疗效,定量资料比较采用单因素方差分析或秩和检验,定性资料比较采用X2或秩和检验。结果3组患者手术时间、术后48h引流量、术后第1天的PLT计数和术后住院天数的差异均有统计学意义（P〈0．05）。中位随访时间为34．5个月,其血液学疗效有明显差异（P=0．046）。结论ITP患者术前PLT计数与LS手术结果和血液学疗效有密切关系。术前应尽量提升PLT计数,降低手术风险。     

特发性血小板减少性紫癜脾切除后远期疗效判断

目的　探讨特发性血小板减少性紫癜(ITP) 脾切除后远期疗效的判断指标。方法　远期随访1980 年5 月至1995 年11 月脾切除治疗ITP106 例。结果　具下述指标的病人远期疗效较好:①年龄≤14 岁。②术后一周内血小板达100 ×109/L。③术后血小板峰值达200 ×109/L。④脾脏重量为平均值的2 倍左右。⑤脾脏淋巴滤泡平均直径500μm 。⑥生发中心平均直径200μm 。结论　上述指标均可在脾切除后1 ～2 周获得,综合这些指标,对远期疗效可作一判断。     

Associate factors for endoscopic submucosal dissection operation time and postoperative delayed hemorrhage of early gastric cancer

BACKGROUND Endoscopic submucosal dissection(ESD) is a treatment for early gastric cancer with the advantages of small invasion, fewer complications, and a low local recurrence rate. However, there is a high risk of complications such as bleeding and perforation, and the operation time is also longer. ESD operation time is closely related to bleeding and perforation.AIM To investigate the influencing factors associated with ESD operation time and postoperative delayed hemorrhage to provide a refe...     

The significance of delayed post-traumatic renal hemorrhage

An impression is presented pertaining to the significance of delayed recurrent post-traumatic renal hematuria, documented by 3 case reports and an appraisal of relevant data selected from prior reports. Adjunctive features may include prolonged initial hematuria despite acceptable radiographic features, a preponderant relationship to penetrating (knife and low velocity missile) wounds and a tendency to respond temporarily to conservative management.     

Image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage

BACKGROUND: Spontaneous ICH is a devastating disease with high morbidity and mortality. Intracerebral hemorrhage lacks an effective medical or surgical treatment despite the acknowledged pathophysiologic benefits of achieved hemostasis and clot removal. Image-guided stereotactic endoscopic hematoma evacuation is a promising minimally invasive approach designed to limit operative injury and maximize hematoma removal. METHODS: A single-center randomized controlled trial was designed to assess the safety and efficacy of stereotactic hematoma evacuation compared to best medical management. Patients were randomized within 24 hours of hemorrhage in a 3:2 fashion to best medical management plus endoscopic hematoma evacuation or best medical management alone. Data were collected to assess efficacy and safety of hematoma evacuation and to identify procedural components requiring technical improvement. RESULTS: Ten patients have been enrolled and randomized to treatment. Six patients underwent endoscopic evacuation with a hematoma volume reduction of 80% +/- 13% at 24 hours post procedure. The medical arm demonstrated a hematoma enlargement of 78% +/- 142% during this same period. Rehemorrhage rates and deterioration rates were similar in the 2 groups. Mortality was 20% in the endoscopic group and 50% in the medical treatment cohort. The endoscopic technique was shown to be effective in identification and evacuation of hematomas, whereas reduction in the number of endoscopic passes and maintenance of hemostasis require further study. CONCLUSION: Image-guided stereotactic endoscopic hematoma removal is a promising minimally invasive technique that is effective in immediate hematoma evacuation. This technique deserves further investigation to determine its role in ICH management.     

Subfascial hemorrhage after endoscopic perforator vein ligation

Ligation of perforator veins in the lower extremity for the treatment of venous ulceration can be performed using a minimally invasive technique with endoscopic instruments. Several studies have documented that the endoscopic technique has a lower wound-related complication rate compared to open perforator vein ligation. We report the complication of postoperative subfascial hemorrhage requiring reexploration after subfascial endoscopic perforator vein ligation and describe a minimally invasive method for its control using balloon tamponade. Received: 15 January 1997/Accepted: 7 May 1997