中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
Chinese Journal of Digestive Surgery
2015年
9期
746-749
,共4页
紫癜,血小板减少性,免疫性%脾切除术%腹腔镜检查%随访
紫癜,血小闆減少性,免疫性%脾切除術%腹腔鏡檢查%隨訪
자전,혈소판감소성,면역성%비절제술%복강경검사%수방
Purpura,thrombocytopenic,idiopathic%Splenectomy%Laparoscopy%Follow-up
目的 探讨腹腔镜脾切除术治疗免疫性血小板减少性紫癜(ITP)的临床疗效.方法 回顾性分析2007年1月至2014年1月重庆医科大学附属第一医院收治的84例ITP患者的临床资料.手术方式采用腹腔镜脾切除术.对可能是预测术后疗效的指标(性别、年龄、病程、术前对激素反应、术前PLT、手术时间、术中出血量、术后7d内PLT峰值)进行收集、整理、分析.手术疗效的评估参照美国血液学协会ITP疗效评判的标准.将完全反应和部分反应设为有效,将无反应设为无效.术后通过门诊和电话进行随访,随访内容包括PLT、有无出血表现、有无长期并发症、术后复发情况等,随访时间截至2014年12月.正态分布的计量资料采用(x)±s表示,偏态分布的计量资料采用中位数M(范围)表示.Kaplan-Meier法评估患者术后长期有效率.单因素分析采用x2检验.多因素分析采用Logistic回归模型.结果 84例患者手术时间为(154±40) min,术中中位出血量为200 mL(10 ～1 000 mL);术中发现副脾11例,均予以切除.7例患者术后出现并发症,经对症支持治疗痊愈,无一例发生围术期死亡.84例患者平均随访时间为51个月(12 ～96个月),45例患者完全反应,18例患者部分反应,21例患者无反应.18例部分反应患者行内科对症治疗.21例无反应患者均继续服用泼尼松龙治疗,其中13例患者能稳定维持PLT＞ 30×109/L.随访期间所有患者无严重自发性脏器及颅内出血.随访期间84例患者中,1例完全反应患者术后2年因肺癌全身转移死亡,其余无死亡.4例患者发生肺炎,1例无反应女性患者长期反复发作化脓性胸膜炎,均予以对症支持治疗痊愈.其余患者未发生严重并发症,无凶险性脾切除术后感染发生.84例患者术后1、3、5、7年有效率分别为82.1％、77.6％、72.5％、67.9％.单因素分析结果显示:患者术前对激素反应、术前PLT、术后7d内PLT峰值是影响ITP患者长期疗效的相关因素(x2=5.600,6.006,21.733,P＜0.05);而患者性别、年龄、病程、手术时间、术中出血量不是影响ITP患者长期疗效的相关因素(x2=0.018,2.684,0.000,0.064,0.397,P＞0.05).多因素分析结果显示:患者术前对激素有反应和术后7d内PLT峰值≥300×109/L是影响ITP患者长期疗效的独立保护因素(OR=5.426,19.454,95％可信区间:1.220～24.129,4.704～80.449,P＜0.05).结论 腹腔镜脾切除术治疗ITP安全、可行,长期有效率高;术前对激素反应、术后7d内PLT峰值可能是预测腹腔镜脾切除术治疗ITP长期疗效的指标.
目的 探討腹腔鏡脾切除術治療免疫性血小闆減少性紫癜(ITP)的臨床療效.方法 迴顧性分析2007年1月至2014年1月重慶醫科大學附屬第一醫院收治的84例ITP患者的臨床資料.手術方式採用腹腔鏡脾切除術.對可能是預測術後療效的指標(性彆、年齡、病程、術前對激素反應、術前PLT、手術時間、術中齣血量、術後7d內PLT峰值)進行收集、整理、分析.手術療效的評估參照美國血液學協會ITP療效評判的標準.將完全反應和部分反應設為有效,將無反應設為無效.術後通過門診和電話進行隨訪,隨訪內容包括PLT、有無齣血錶現、有無長期併髮癥、術後複髮情況等,隨訪時間截至2014年12月.正態分佈的計量資料採用(x)±s錶示,偏態分佈的計量資料採用中位數M(範圍)錶示.Kaplan-Meier法評估患者術後長期有效率.單因素分析採用x2檢驗.多因素分析採用Logistic迴歸模型.結果 84例患者手術時間為(154±40) min,術中中位齣血量為200 mL(10 ～1 000 mL);術中髮現副脾11例,均予以切除.7例患者術後齣現併髮癥,經對癥支持治療痊愈,無一例髮生圍術期死亡.84例患者平均隨訪時間為51箇月(12 ～96箇月),45例患者完全反應,18例患者部分反應,21例患者無反應.18例部分反應患者行內科對癥治療.21例無反應患者均繼續服用潑尼鬆龍治療,其中13例患者能穩定維持PLT＞ 30×109/L.隨訪期間所有患者無嚴重自髮性髒器及顱內齣血.隨訪期間84例患者中,1例完全反應患者術後2年因肺癌全身轉移死亡,其餘無死亡.4例患者髮生肺炎,1例無反應女性患者長期反複髮作化膿性胸膜炎,均予以對癥支持治療痊愈.其餘患者未髮生嚴重併髮癥,無兇險性脾切除術後感染髮生.84例患者術後1、3、5、7年有效率分彆為82.1％、77.6％、72.5％、67.9％.單因素分析結果顯示:患者術前對激素反應、術前PLT、術後7d內PLT峰值是影響ITP患者長期療效的相關因素(x2=5.600,6.006,21.733,P＜0.05);而患者性彆、年齡、病程、手術時間、術中齣血量不是影響ITP患者長期療效的相關因素(x2=0.018,2.684,0.000,0.064,0.397,P＞0.05).多因素分析結果顯示:患者術前對激素有反應和術後7d內PLT峰值≥300×109/L是影響ITP患者長期療效的獨立保護因素(OR=5.426,19.454,95％可信區間:1.220～24.129,4.704～80.449,P＜0.05).結論 腹腔鏡脾切除術治療ITP安全、可行,長期有效率高;術前對激素反應、術後7d內PLT峰值可能是預測腹腔鏡脾切除術治療ITP長期療效的指標.
목적 탐토복강경비절제술치료면역성혈소판감소성자전(ITP)적림상료효.방법 회고성분석2007년1월지2014년1월중경의과대학부속제일의원수치적84례ITP환자적림상자료.수술방식채용복강경비절제술.대가능시예측술후료효적지표(성별、년령、병정、술전대격소반응、술전PLT、수술시간、술중출혈량、술후7d내PLT봉치)진행수집、정리、분석.수술료효적평고삼조미국혈액학협회ITP료효평판적표준.장완전반응화부분반응설위유효,장무반응설위무효.술후통과문진화전화진행수방,수방내용포괄PLT、유무출혈표현、유무장기병발증、술후복발정황등,수방시간절지2014년12월.정태분포적계량자료채용(x)±s표시,편태분포적계량자료채용중위수M(범위)표시.Kaplan-Meier법평고환자술후장기유효솔.단인소분석채용x2검험.다인소분석채용Logistic회귀모형.결과 84례환자수술시간위(154±40) min,술중중위출혈량위200 mL(10 ～1 000 mL);술중발현부비11례,균여이절제.7례환자술후출현병발증,경대증지지치료전유,무일례발생위술기사망.84례환자평균수방시간위51개월(12 ～96개월),45례환자완전반응,18례환자부분반응,21례환자무반응.18례부분반응환자행내과대증치료.21례무반응환자균계속복용발니송룡치료,기중13례환자능은정유지PLT＞ 30×109/L.수방기간소유환자무엄중자발성장기급로내출혈.수방기간84례환자중,1례완전반응환자술후2년인폐암전신전이사망,기여무사망.4례환자발생폐염,1례무반응녀성환자장기반복발작화농성흉막염,균여이대증지지치료전유.기여환자미발생엄중병발증,무흉험성비절제술후감염발생.84례환자술후1、3、5、7년유효솔분별위82.1％、77.6％、72.5％、67.9％.단인소분석결과현시:환자술전대격소반응、술전PLT、술후7d내PLT봉치시영향ITP환자장기료효적상관인소(x2=5.600,6.006,21.733,P＜0.05);이환자성별、년령、병정、수술시간、술중출혈량불시영향ITP환자장기료효적상관인소(x2=0.018,2.684,0.000,0.064,0.397,P＞0.05).다인소분석결과현시:환자술전대격소유반응화술후7d내PLT봉치≥300×109/L시영향ITP환자장기료효적독립보호인소(OR=5.426,19.454,95％가신구간:1.220～24.129,4.704～80.449,P＜0.05).결론 복강경비절제술치료ITP안전、가행,장기유효솔고;술전대격소반응、술후7d내PLT봉치가능시예측복강경비절제술치료ITP장기료효적지표.
Objective To investigate the clinical efficacy of laparoscopic splenectomy (LS) for immune thrombocytopenic purpura (ITP).Methods The clinical data of 84 patients with ITP who underwent LS at the First Affiliated Hospital of Chongqing Medical University from January 2007 to January 2014 were retrospectively analyzed.The potential prognosing indexes (gender,age,course of diseas,preoperative response to steroid,preoperative PLT,operation time,volume of intraoperative blood loss and postoperative PLT peak within 7 days) were collected and analyzed.The evaluation of surgical efficacy was done according to the American Society of Hematology 2011 evidence-based practice guideline for ITP.The complete response and partial response were defined as effective and no response as void.All of the patients were followed up by outpatient examination and telephone interview till December 2014,the follow-up information included platelet count,bleeding performance,presence of long-term complications and postoperative recurrence,etc.Measurement data with normal distribution were presented as x ± s,and skew distribution data were described as M (range).The postoperative long-term effective rate was analyzed by Kaplan-Meier method.The univariate analysis and multivariate analysis were done using the chi-square test and Logistic regression model,respectively.Results The operation time of 84 patients was (154 ±40)minutes with a median volume of intraoperative blood loss as 200 mL (10-1 000 mL).Lienculus was detected in 11 patients and resected.Seven patients had complications and recovered after symptomatic and supportive treatment.There was no perioperative death.Among the 84 patients who were followed up for an average follow-up time of 51 months (12-96 months),45 patients had complete response,18 patients had partial response and 21 had no response,without serious spontaneous visceral and intracranial hemorrhage.Eighteen partial-response patients underwent symptomatic medical therapy and 21 no-response patients took orally prednisolone,among which 13 had PLT ＞ 30 × 109/L stably.During the follow-up,only one complete-response patient died of lung cancer with systemic metastasis at 2 years after surgery.Four patients had pneumonia,1 noresponse female patient had pyothorax repeatedly for a long time,and they all recovered after symptomatic and supportive treatments.There were no serious complications and overwhelming postsplenectomy infection in other patients.The 1-,3-,5-,7-year effective rates were 82.1％,77.6％,72.5％ and 67.9％,respectively.Univariate analysis showed that preoperative response to steroid,preoperative PLT and postoperative PLT peak within 7 days were related factors affecting long-term effecacy of patients with ITP (x2=5.600,6.006,21.733,P ＜ 0.05),but gender,age,course of disease,operation time and volume of intraoperative blood loss were not related factors affecting long-term effecacy of patients with ITP (x2=0.018,2.684,0.000,0.064,0.397,P ＞ 0.05).Multivariate analysis showed that preoperative response to steroid and postoperative PLT peak within 7 days ≥300 × 109/L were independent protective factors affecting long-term efficacy (OR =5.426,19.454,95％ confidence interval:1.220-24.129,4.704-80.449,P ＜ 0.05).Conclusions LS is safe and feasible for the treatment of ITP with a high long-term effective rate.Preoperative response to steroid and postoperative PLT peak within 7 days may be the predictors of LS for ITP.
