Department of Intensive Care Unit, Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 1508935, Japan.
J Anesth. 2012 Oct;26(5):766-9. doi: 10.1007/s00540-012-1392-8. Epub 2012 Apr 24.
We report the successful management of a female patient who developed postoperative thrombotic thrombocytopenic purpura (TTP) after an uneventful laparoscopic oophorocystectomy. The patient underwent uneventful laparoscopic surgery for ovarian cystoma. One hour after completion of surgery, the patient suddenly went into shock, with her blood pressure dropping to 60/40 mmHg. Hemorrhage into the abdominal cavity with an estimated blood loss of 2,000 ml was confirmed by exploratory laparotomy. Initially, anemia and thrombocytopenia were attributed to blood consumption or disseminated intravascular coagulation (DIC). However, blood tests revealed evidence of hemolytic anemia, with fragmented erythrocytes observed on peripheral blood smear examination. Serum levels of lactate dehydrogenase, blood urea nitrogen, and creatinine were elevated. Based on the findings, postoperative TTP was suspected. High-dose steroids and plasma infusions were administered but proved ineffective. Plasma exchange was performed three times, resulting in resolution of postoperative TTP. TTP is an idiopathic disorder, known to be triggered by surgical trauma. Postoperative TTP is difficult to distinguish clinically from DIC because of its close similarity with the latter and subtle differences from other postoperative hematological complications. It is important to bear in mind the possibility of postoperative TTP in patients with unexplained hemorrhagic shock after uneventful surgery.
我们报告了一例女性患者在腹腔镜卵巢囊肿切除术后成功治疗术后血栓性血小板减少性紫癜（TTP）的病例。患者行腹腔镜卵巢囊肿切除术，手术过程顺利。术后 1 小时，患者突然发生休克，血压降至 60/40mmHg。剖腹探查证实腹腔内出血，估计出血量为 2000ml。最初，贫血和血小板减少被归因于血液消耗或弥漫性血管内凝血（DIC）。然而，血液检查显示存在溶血性贫血的证据，外周血涂片检查可见破碎红细胞。血清乳酸脱氢酶、血尿素氮和肌酐水平升高。根据这些发现，怀疑术后 TTP。给予大剂量类固醇和血浆输注，但无效。进行了三次血浆置换，术后 TTP 得到缓解。TTP 是一种特发性疾病，已知由手术创伤引发。由于术后 TTP 与 DIC 非常相似，且与其他术后血液学并发症略有不同，因此临床上很难与 DIC 区分。对于手术顺利但出现不明原因出血性休克的患者，要记住术后 TTP 的可能性。
