脾切除治疗特发性血小板减少性紫癜的临床分析

目的 探讨脾切除对内科治疗无效或反复复发的特发性血小板减少性紫癜（ITP）的疗效.方法 对经内科治疗无效的53例ITP患者行脾切除术,观察其疗效.全组患者术后随访2～10年,平均3.6年.结果 术后3d恢复正常（血小板＞ 100X109/L）者24例,占45.3％;术后2个月时血小板在正常范围者36例,治愈率67.9％,显效9例,总有效率84.9％.长期随访发现3例复发,复发率5.7％.结论 对内科治疗无效的TIP患者,脾切除治疗有效,术后血小板回升幅度较高者预后较好.     

脾切除治疗特发性血小板减少性紫癜22例

目的 观察脾切除术治疗特发性血小板减少性紫癜(ITP)的疗效及并发症.方法 22例ITP患者术前均为皮质激素治疗无效或皮质激素依赖,采用开腹脾切除术3例,腹腔镜下脾切除术19例.结果 22例患者获随访6～60个月.术后半年显效18例,良效1例,进步3例,总有效率为86.4%(19/22).术后1年20例获随访,显效11...     

部分脾动脉栓塞术在ITP中的应用(附26例报告)

目的:探讨部分性脾动脉栓塞术 (PSE)治疗特发性血小板减少性紫癜(ITP)的临床价值.方法:对26例经内科治疗效差或无效的ITP患者进行部分性脾栓塞术治疗,观察其疗效、毒副作用.结果:显效13例,良效8例,进步5例.近期疗效84.62%,远期疗效:有效病例中9例20～60天后血小板下降,经内科治疗血小板维持25×109～80×109/L,无出血倾向,暂无死亡病例.副作用包括脾区疼痛、发热、左侧胸腔积液、脾脓肿.结论:部分脾动脉栓塞术对内科治疗效差或无效,激素治疗禁忌,心肾功能不全,血小板较低的原发性血小板减少性紫癜患者是一种具有创伤小,安全性好,疗效可靠的方法,值得推广开展.     

ITP患者脾切除后血小板变化的研究

特发性血小板减少性紫癜（idiopathic thrombo cytopenic purpura，ITP）是临床常见的出血性疾病。部分慢性反复发作经内科药物治疗效果不佳，或严重出血不能控制者，采用脾切除治疗有效率70％～90％。通常脾切除术后可导致血小板升高，血液黏稠度增加，严重者可致血栓形成。2007年1月-2009年7月我院共施行ITP脾全切术54例，有效52例，现报道如下。     

脾切除治疗36例血液病的临床分析

目的　总结对血液病病人行脾切除的治疗效果与适应症。方法　回顾性分析和随访 1986 - 2 0 0 0年内 36例血液病脾切除术患者的资料 ,根据治疗效果 ,总结出适应症。结果　脾切除对内科治疗无效的原发性血小板减少性紫癜 (ITP)、遗传性球形红细胞增多症 (HS)、自身免疫性溶血性贫血 (AHA)有确切的治疗效果 ,有效率相应为 91%、80 %和 75 %。结论　脾切除可作为对内科治疗无效的原发性血小板减少性紫癜、遗传性球形红细胞增多症、自身免疫性溶血性贫血患者的有效治疗。     

机采血小板悬液在ITP患者腹腔镜脾切除术中的应用

目的：探讨机采血小板悬液对特发性血小板减少性紫癜(ITP)患者行腹腔镜脾切除术中出血的防治作用。方法：回顾性分析总结1999—2003年间38例ITP患者在腹腔镜脾切除手术中机采血小板悬液应用的临床资料。结果：机采血小板悬液可有效防治ITP患者腹腔镜脾切除术中出血，总有效率为92．1％。结论：机采血小板悬液输注是ITP患者腹腔镜脾切除术中防治出血的有效治疗方法。     

大剂量静注免疫球蛋白治疗难治性特发性血小板减少性紫癜

特发性血小板减少性紫癜(ITP)是一种由于血小板自身抗体所致血小板减少性疾病。成人ITP用糖皮质激素和/或脾切除等常规治疗完全缓解率可达60-70％,约10—10％的ITP患者对常规治疗无反应,这一部分患者的治疗十分棘手,尤其是当病人BPC低于5～10×10~9/L,出现严重的粘膜出血,存在中枢神经系统出血的危险时。     

脾切除治疗慢性特发性血小板减少性紫癜13例临床分析

目的:分析脾切除治疗慢性特发性血小板减少性紫癜(CITP)的疗效。方法:对13例CITP患者在皮质激素治疗效果不佳或有皮质激素治疗禁忌、不能耐受等情况下采用脾切除治疗。结果:13例患者接受脾切除治疗6个月后的总有效率92%,1年后总有效率85%,3年总有效率77%。结论:慢性特发性血小板减少性紫癜患者在不能或不愿意继续使用糖皮质激素治疗时,采用脾切除治疗是一种切实可行的方法。     

血液病脾切除手术期处理

目的研究脾切除对原发性血小板减少性紫癜的治疗效果.方法对1983年~2004年内科治疗无效的63例原发性血小板减少性紫瘢(ITP)患者行脾切除手术并对其临床疗效进行观察.全组患者术后随访2个月至16年,平均4.7年,其中随访半年以上者48例.结果术前全部患者均有出血症状,血小板平均24×109/L,术后1、3、5、7天血小板平均值分别上升为110×109/L、202×109/L、251×109/L和246×109/L,其中血小板一周内恢复正常(≥100×109/L)者51例,占80.9%;术后2个月时血小板在正常范围者45例,治愈率73.8%,显效率13.1%,总有效率为86.9%.对39例手术有效的病例长期随访,发现7例复发,复发率17.9%.结论儿童组疗效略好于成人组,但差异无显著性意义;术前病程长短与手术疗效无相关关系;术后血小板回升较早及回升幅度较高者预后较好.观察患者术后骨髓像的改变可能是预测ITP远期疗效的指标之一.     

部分脾栓塞术治疗难治性原发性血小板减少性紫癜疗效观察

目的观察部分脾栓塞术(partial splenicembolization,PSE)治疗难治性原发性血小板减少性紫癜(re-fractory idiopathic thrombocytopenic purpura,R-ITP)的治疗效果。方法对24例经正规内科药物治疗无效的原发性血小板减少性紫癜患者行部分脾栓塞术后随访3个月～4年观察其临床疗效及血小板计数的变化。结果术后所有患者血小板均有不同程度的上升。显效11例,良效8例,进步2例,总有效率79.1%。结论部分脾栓塞治疗R-ITP有明显疗效。     

激素治疗无效的特发性血小板减少性紫癜的治疗方法探讨

目的回顾性分析比较脾切除术和免疫抑制剂分别对肾上腺糖皮质激素治疗不敏感或激素依赖的特发性血小板减少性紫癜（ITP）患者的疗效,以探讨适宜的二线治疗方案。方法收集广州市5家三级甲等医院,1997—2007年近10年间住院的所有诊断为ITP且对激素治疗无效的患者共52例,对其临床资料进行分析。根据不同的治疗方案将其分为2组,A组20例为脾切除组,B组32例为使用免疫抑制剂组（包括环孢菌素A、硫唑嘌呤、长春新碱,环磷酰胺）。分别比较两组患者在治疗前、治疗后第3天、7天、1月、6月、24月时的血小板计数（BPC）及治疗副作用。结果A组患者从治疗第3天起至24个月BPC均高于B组,差异有显著性（P〈0．05）。A组的总有效率高于B组,差异有显著性（P〈0．05）。A组治疗副作用包括术中出血、伤口愈合不良、脾切后继发感染等,发生率为15．0％;B组治疗不良反应包括感染、骨髓抑制、肝损害、‘肾损害、出血性膀胱炎、末梢性周围神经炎及其他等,发生率为45．0％。其中4例免疫抑制剂治疗无效的患者行脾切除后仍能达到有效。个别切脾后疗效不佳者仅需小剂量激素和（或）联用免疫抑制剂维持。结论对激素治疗不敏感或激素依赖的ITP患者,脾切除治疗起效时间快,效果好,副作用少,可作为激素治疗失败或不能耐受者的首选二线治疗方法。     

Chronic idiopathic thrombocytopenic purpura in adult Chinese patients: a retrospective single-centered analysis of 1791 cases

Background Adult chronic idiopathic thrombocytopenic purpura (ITP) is a common hematologic disease characterized by persistent thrombocytopenia. So far, there were only a few reports on adult Chinese patients with chronic ITP. This study aimed at defining the treatment outcome and prognostic factors for chronic ITP based on a large cohort of Chinese patients followed up for over 25 years at a single center.Methods The medical records of 1791 patients aged 14 years or older who were diagnosed as having chronic ITP at our hospital from 1974 to 1999 were retrospectively analyzed.Results The female-to-male ratio was 2∶1, with a median age of 34 years (ranging from 14 to 80 years), median platelet count of 38×10（9）/L ［range （1-99）×10（9）/L］, and median follow-up of 36 months (range 1-220 months). Steroids were used in 689 patients, among them 209 (30.3%) achieved complete remission (CR). A splenectomy was performed in 124 patients, and response to steriod pre-splenectomy was not available in 14 patients. The CR rate after a splenectomy was lower in steroid nonresponders (29 of 90, 32.2%) than in those who relapsed after successful steroid treatment (12 of 20, 60.0%) (P<0.05). In comparison with patients negative for antinuclear antibody (ANA), those who were ANA positive had similar responses to steroids, but a significantly shorter remission period after a splenectomy (P<0.01).Conclusions Adult Chinese chronic ITP patients can have long-term remission after steroid therapy and splenectomies. Primary steroid refractoriness is a prognostic factor predicting poor subsequent response to a splenectomy.     

腹腔镜脾切除术治疗免疫性血小板减少性紫癜——单个教学医院经验

Background  High anatomic location, fragility, and generous blood supply of the spleen makes laparoscopic splenectomy (LS) difficult to master, and few patients need splenectomy for benign disorders. The aim of this research was to assess operative outcomes and hematological results of a large series of patients treated with LS for chronic immune thrombocytopenic purpura (ITP) and to determine which clinical variables predict favorable hematological outcome.

Methods  LS was successfully performed for 154 patients with chronic ITP from September 1999 to April 2009 at the First Affiliated Hospital of Sun Yat-sen University. Operative outcomes were assessed retrospectively. Long-term follow-up data were obtained from outpatient medical records and phone interviews. Clinical and laboratory variables (including gender, age, disease duration before surgery, previous response to steroids, preoperative platelet count, and postoperative peak platelet count) were evaluated by univariate analysis to identify potential predictors of hematological outcome. Multivariate Logistic regression model was used to determine independent predictors of hematological outcome.

Results  One patient died from subphrenic abscess and postoperative sepsis. The overall major morbidity rate was 8.4%. None of the patients required a second surgery for complications. Of the 127 patients available for a mean follow-up of 43.6 months (range 9–114 months), the overall initial response (i.e., at two months after LS) and long-term response to LS were achieved in 89.0% and 80.3%, respectively. Five patients (3.9%) developed pneumonia 3–35 months after LS. Univariate analysis showed a significant difference in mean age between responders (29.1 years) and nonresponders (38.8 years; P <0.05). Patients who responded to steroid therapy had better hematological outcome than those who did not respond (P <0.05). Compared to nonresponders, responders to LS had a significantly higher postoperative peak platelet count (404×10⁹/L versus 213×10⁹/L, P <0.001). Multivariate Logistic regression analysis identified postoperative peak platelet count as the only independent predictor of favorable response to LS ( P <0.001).

Conclusions  LS is a safe and effective treatment for chronic ITP. Postoperative peak platelet count may serve as a major predictor of long-term response.

     

腹腔镜脾切除术治疗特发性血小板减少性紫癜临床应用研究

目的探讨腹腔镜脾切除术治疗特发性血小板减少性紫癜(ITP)的手术安全性、可行性及临床疗效。方法1999年12月至2004年12月对30例ITP患者行腹腔镜脾切除术，并对其临床资料进行回顾性分析。结果30例ITp患者腹腔镜手术成功率达93．3％，2例中转开腹手术；平均手术时间130min，术中失血平均100ml。全组均于术后24h内恢复胃肠蠕动，术后6h可下床活动。平均住院时间4．5d。术后1周内血小板很快上升。治疗有效率达93．3％。发生并发症3例：2例皮下气肿，1例隔下积液。平均随访24个月，3例复发，总有效率为90％。结论腹腔镜脾切除术治疗ITP安全可行，且疗效显著，给ITP患者提供了新的微创治疗方法。     

特发性血小板减少性紫癜治疗方案的选择

目的评价特发性血小板减少性紫癜（ITP）治疗方案。方法采用回顾性病例分析，对各组治疗ITP的有效率、血小板上升速度进行比较。结果单纯激素治疗组、激素加免疫抑制剂组、脾切除组的有效率分别为75％、41、7％、85％。血小板上升至正常的时间分别为（7，3±3．20）d、（16．01±4．07）d、（2，52±1．48）d。脾切除组的有效率及血小板上升速度优于另两组，P〈0.05（组间比较t检验）。结论激素应作为ITP治疗首选方案，对于不能用激素维持及减量后复发的病人，应尽早做脾切除。     

重症特发性血小板减少性紫癜21例临床分析

目的分析重症特发性血小板减少性紫癜（ITP）治疗的临床疗效及预后转归。方法对21例重症ITP患者初始给予糖皮质激素＋静脉免疫球蛋白±血小板输注的联合治疗方案;对幽门螺杆菌感染阳性的患者给予抗HP根治治疗;对多种治疗措施不能持久符合切脾指征的患者行切脾术;观察治疗后临床出血症状及血小板计数的变化。结果 21例联合方案治疗初始完全反应约占90%,无效约占10%;4例幽门螺杆菌检测阳性的患者给予抗HP治疗,2例有效;4例切脾患者3例完全反应。结论初始联合治疗方案对患者度过危险期,改善出血症状疗效显著;对ITP患者应常规行幽门螺杆菌检测;切脾治疗ITP效果肯定。     

Helicobacter pylori eradication: a novel therapeutic option in chronic immune thrombocytopenic purpura

OBJECTIVE: To determine whether Helicobacter pylori eradication is an effective treatment for Australian patients with chronic immune thrombocytopenic purpura (ITP). DESIGN, SETTING AND PATIENTS: Retrospective analysis of clinical records of a consecutive series of ITP patients referred to a gastrointestinal surgeon in a tertiary referral hospital for laparoscopic splenectomy between August 2005 and November 2007. MAIN OUTCOME MEASURES: Platelet response (measured at least 3-monthly) following successful H. pylori eradication therapy (confirmed by urea breath test 4 weeks later). RESULTS: Of 16 patients, seven were H. pylori-negative and underwent laparoscopic splenectomy. Nine were H. pylori-positive and successfully underwent H. pylori eradication therapy; five of the nine had an initial platelet response. Four patients had platelet counts > 100 x 10(9)/L (reference range, 140-450 x 10(9)/L) and were off all immunosuppression at 9 months; three had a sustained response beyond 12 months. One patient had an initial response at 3 months (15 x 10(9)/L to 208 x 10(9)/L), but relapsed 4 months after H. pylori eradication and underwent splenectomy with platelet count recovery. The remaining four patients showed no platelet response and subsequently underwent splenectomy. CONCLUSION: Larger prospective studies are needed to fully ascertain the role of H. pylori in Australian patients with ITP. However, H. pylori eradication is simple and safe. H. pylori screening and eradication should be considered before immunosuppression or splenectomy.     

High doses of dexamethasone in adult patients with idiopathic thrombocytopenic purpura

BACKGROUND: High-dose dexamethasone (DXM) has been used in treatment of patients with idiopathic thrombocytopenic purpura (ITP) who are refractory to other treatments such as prednisone and splenectomy; nevertheless, different studies show variable success rates, this postulated as possibly being due to racial differences. The objective of this study was to determine DXM effectiveness at high doses in Mexican mestizo adult patients diagnosed with ITP with and without splenectomy. METHODS: Nonhospitalized adult patients with ITP were included, eight patients previously splenectomized (group 1) and 11 who had not undergone splenectomy (group 2). Patients received DXM 40 mg/day intravenously (i.v.) during 4 consecutive days every 4 weeks until six cycles were completed. RESULTS: There were no differences between the two groups regarding age (mean 39 vs. 33 years of age) and initial platelet count (M 17 vs. 24 x 10(9)/L). Median evolution time was 84 months for group 1 and 7 months for group 2 (p = 0.002). Of 19 patients, nine achieved a favorable response (FR), six belonged to group 1, and three to group 2 (Fisher p = 0.07). Nevertheless, after 6 months only two group 1 patients and two group 2 patients maintained FR (Fisher exact test p = 1). Patients achieving FR to initiation of second cycle maintained FR at the end of six cycles. CONCLUSIONS: Thus, the previously mentioned high-dose DXM therapy appears to be useful for both patients with ITP with and without splenectomy and high-dose DXM appears to be a good alternative therapy for postsplenectomy and relapse patients. However, duration of FR to treatment was brief; therefore, other treatment plans might be required to achieve longer remission duration. Response was similar to that observed in other studies carried out in different populations; thus, apparently no genetic or racial variations exist. In addition, whether patients not responding after second cycle should continue until completing the 6-month plan or should try a different therapeutic approach must be considered in the treatment plan.     

98例急性特发性血小板减少性紫癜临床分析

目的:分析儿童急性特发性血小板减少性紫癜不同治疗方案的疗效.方法:收集98例我院2005年1月至2007年1月收治的特发性血小板减少性紫癜儿童患者的病历资料,分析儿童急性特发性血小板减少性紫癜不同治疗方案的疗效.结果:①激素组的有效率为:79.59%(39/49),显效率为67.34%(33/49);丙种球蛋白加泼尼松...