Kang Chang Moo, Lee Jae Gil, Kim Kyung Sik, Choi Jin Sub, Lee Woo Jung, Kim Byong Ro, Ko Yoon Woong, Han Ji Sook, Min Yoo Hong
Department of Surgery, Yonsei University, College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, Korea.
J Korean Med Sci. 2007 Jun;22(3):420-4. doi: 10.3346/jkms.2007.22.3.420.
Laparoscopic splenectomy (LS) has been reserved for intractable and relapsing immune thrombocytopenic purpura (ITP) despite medical treatment. With further experiences of LS in ITP, we investigated long term outcomes of LS, especially newly developed morbidities, and tried to find predictive factors for favorable outcomes. From August 1994 to December 2004, fifty-nine patients whose follow-up period was more than 12 months after LS were investigated. After a long-term follow-up (median 54 months, range 12.5-129 months), a complete response (CR) was found in 28 patients (47.5%), partial response in 24 (40.7%), and no response in 7 (11.9%). The relapse rate during follow-up periods was 15.2%. The rapid response group (p=0.017), in which the platelet count increased more than twice of the preoperative platelet count within 7 days after LS, relapsing after medical treatment (p=0.02), and the satisfactory group as the initial result of LS (p=0.001) were significant for predicting CR in univariate analysis, but only the initial satisfactory group was an independent predictive factor for CR in multivariate analysis (p=0.036, relative risk=6419; 95% CI, 1.171-35.190). Infections were the most frequent morbidities during the follow-up period, which were treated well without mortality. LS is a safe and effective treatment modality for ITP. Active referral to surgery might be required, considering complications and treatment results related to long-term use of steroid-based medications.
尽管进行了药物治疗，腹腔镜脾切除术（LS）仍用于治疗难治性和复发性免疫性血小板减少性紫癜（ITP）。随着LS治疗ITP经验的不断积累，我们研究了LS的长期疗效，尤其是新出现的并发症，并试图找出预测良好疗效的因素。对1994年8月至2004年12月期间接受LS治疗且随访期超过12个月的59例患者进行了调查。经过长期随访（中位时间54个月，范围12.5 - 129个月），28例患者（47.5%）完全缓解（CR），24例（40.7%）部分缓解，7例（11.9%）无缓解。随访期间的复发率为15.2%。在单因素分析中，快速反应组（血小板计数在LS后7天内增加至术前血小板计数的两倍以上，p = 0.017）、药物治疗后复发（p = 0.02）以及LS初始结果为满意组（p = 0.001）对预测CR具有显著意义，但在多因素分析中，只有初始满意组是CR的独立预测因素（p = 0.036，相对危险度 = 6419；95%可信区间，1.171 - 35.190）。感染是随访期间最常见的并发症，经治疗后恢复良好，无死亡病例。LS是治疗ITP的一种安全有效的治疗方式。考虑到与长期使用类固醇类药物相关的并发症和治疗结果，可能需要积极转诊进行手术。
