Griffiths Jill, Sia Winnie, Shapiro A M James, Tataryn Ivanna, Turner A Robert
Department of Obstetrics and Gynecology, University of Alberta, Edmonton AB.
J Obstet Gynaecol Can. 2005 Aug;27(8):771-4. doi: 10.1016/s1701-2163(16)30729-0.
Immune thrombocytopenic purpura (ITP) is a condition with potential hazard during pregnancy for both mother and fetus if platelet concentrations fall below a critical level. This report describes the use of laparoscopic splenectomy following unsuccessful medical management.
A 35-year-old primigravid woman with systemic lupus erythematosis (SLE) developed ITP several years before becoming pregnant. She was treated early in pregnancy with high-dose oral prednisone and weekly intravenous immunoglobulin (IVIG) alternating with anti-D immune globulin, but laparoscopic splenectomy was indicated at 20 weeks' gestation because of thrombocytopenia. Following surgery, she continued prednisone and intermittent IVIG therapy until spontaneous delivery at 34 weeks' gestation. A small accessory spleen was identified postpartum by nuclear medicine scan. Satisfactory platelet concentrations were maintained postpartum using danazol and prednisone.
Laparoscopic splenectomy is a therapeutic option for women with ITP during pregnancy that fails to respond to medical management.
免疫性血小板减少性紫癜（ITP）是一种在孕期若血小板浓度降至临界水平会对母亲和胎儿都造成潜在危害的病症。本报告描述了在药物治疗失败后进行腹腔镜脾切除术的应用情况。
一名35岁的初产妇，患有系统性红斑狼疮（SLE），在怀孕前数年就患上了ITP。她在孕早期接受了大剂量口服泼尼松以及每周静脉注射免疫球蛋白（IVIG）并交替使用抗-D免疫球蛋白的治疗，但由于血小板减少，在妊娠20周时仍需进行腹腔镜脾切除术。术后，她继续使用泼尼松和间歇性IVIG治疗，直至妊娠34周自然分娩。产后通过核医学扫描发现了一个小的副脾。产后使用达那唑和泼尼松维持了令人满意的血小板浓度。
腹腔镜脾切除术是孕期ITP女性患者药物治疗无效时的一种治疗选择。
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