Davis P W, Williams D A, Shamberger R C
Department of Surgery, Children's Hospital, Boston, MA 02115.
J Pediatr Surg. 1991 Apr;26(4):407-12; discussion 412-3. doi: 10.1016/0022-3468(91)90987-5.
We have reviewed 40 patients with immune thrombocytopenia purpura (ITP) to assess current methods of preparation for surgery and to evaluate perioperative complications and response to splenectomy. Twenty-one patients had chronic ITP (greater than 1 year duration) and 19 patients had severe acute thrombocytopenia (platelet counts less than 10,000). A progression of methods of pretreatment was seen in the 10-year period reviewed. Seventeen patients received no treatment before admission for surgery, and 10 of these received platelet transfusions. Seventeen patients received steroids immediately preceding surgery; 16 of these responded and 1 received a platelet transfusion. Recently, 5 patients received intravenous gamma globulin (IgG) preceding surgery with all patients responding and none receiving platelet transfusions. One patient received a combination of steroids and IgG with good response and did not require platelet transfusion. No major postoperative complications occurred (ie, pancreatitis, small bowel obstruction, or sepsis) except for one patient requiring a secondary exploration for an accessory spleen and recurrent thrombocytopenia. Eight patients (20%), 6 with severe ITP and 2 with chronic ITP (5 males and 3 females) developed recurrence of thrombocytopenia following surgery up to 1 1/2 years after splenectomy. These patients all required further medical therapy. Three additional patients (2 chronic and 1 severe) developed thrombocytopenia following viral illnesses, but required no further therapy. Of the 8 surgical failures, 4 failed to respond to prior treatment with steroids, 1 to IgG, and 2 failed to respond to combination therapy, while one surgical failure responded to both steroid and combination therapy. Of the responders to splenectomy (32 patients), only 3 failed to respond to prior treatment with steroids.(ABSTRACT TRUNCATED AT 250 WORDS)
我们回顾了40例免疫性血小板减少性紫癜（ITP）患者，以评估当前的手术准备方法，并评估围手术期并发症以及脾切除术后的反应。21例患者为慢性ITP（病程超过1年），19例患者为严重急性血小板减少症（血小板计数低于10,000）。在所回顾的10年期间，预处理方法有一个发展过程。17例患者在入院手术前未接受治疗，其中10例接受了血小板输注。17例患者在手术前立即接受了类固醇治疗；其中16例有反应，1例接受了血小板输注。最近，5例患者在手术前接受了静脉注射丙种球蛋白（IgG），所有患者均有反应，且无人接受血小板输注。1例患者接受了类固醇和IgG联合治疗，反应良好，无需血小板输注。除1例因副脾和复发性血小板减少症需要二次探查外，未发生重大术后并发症（即胰腺炎、小肠梗阻或败血症）。8例患者（20%），6例严重ITP患者和2例慢性ITP患者（5例男性和3例女性）在脾切除术后长达1年半出现血小板减少症复发。这些患者均需要进一步的药物治疗。另外3例患者（2例慢性和1例严重）在病毒感染后出现血小板减少症，但无需进一步治疗。在8例手术失败的患者中，4例对先前的类固醇治疗无反应，1例对IgG无反应，2例对联合治疗无反应，而1例手术失败患者对类固醇和联合治疗均有反应。在脾切除术后有反应的患者（32例）中，只有3例对先前的类固醇治疗无反应。（摘要截短至250字）
