脾切除术治疗血液系统疾病的结果和并发症。

Outcomes and complications after splenectomy for hematologic disorders.

机构信息

Department of General and Vascular Surgery, Gundersen Lutheran Health System, 1900 South Ave. C03-006B, La Crosse, WI 54601, USA.

出版信息

Am J Surg. 2012 Dec;204(6):1014-9; discussion 1019-20. doi: 10.1016/j.amjsurg.2012.05.030. Epub 2012 Oct 29.

DOI:10.1016/j.amjsurg.2012.05.030

PMID:23116640

Abstract

BACKGROUND

Splenectomy is generally a second-line therapy in patients with immune thrombocytopenic purpura (ITP) and autoimmune hemolytic anemia (AHA) refractory to medical therapy. Our objective was to evaluate outcomes after splenectomy for these disorders.

METHODS

A retrospective review of the medical records of patients who underwent splenectomy for ITP or AHA from January 1, 1996, to December 31, 2010 was completed.

RESULTS

Sixty patients met the study criteria: 45 with ITP and 15 with AHA. The mean age was 49.4 ± 21.7 years; 63% were women. Initially, 91% and 93% of ITP and AHA patients experienced a complete response (P = .999); however, 17% of ITP and 29% of AHA patients relapsed (P = .443). Sixty-four percent of patients responded after relapse for a complete response rate of 85% (82% in ITP and 93% in AHA, P = .427). Thirty-day and long-term complication rates were 10% and 5%, respectively. There were no splenectomy-related 30-day mortalities.

CONCLUSIONS

Splenectomy for ITP and AHA resulted in favorable response rates with low morbidity and is an effective adjunct in the management course of patients failing to achieve or sustain responses with medical therapy.

摘要

背景

脾切除术通常是对药物治疗无效的免疫性血小板减少性紫癜（ITP）和自身免疫性溶血性贫血（AHA）患者的二线治疗方法。我们的目的是评估这些疾病行脾切除术的结果。

方法

对 1996 年 1 月 1 日至 2010 年 12 月 31 日期间因 ITP 或 AHA 而行脾切除术的患者的病历进行了回顾性分析。

结果

符合研究标准的患者共 60 例：45 例 ITP，15 例 AHA。平均年龄为 49.4±21.7 岁；63%为女性。最初，91%和 93%的 ITP 和 AHA 患者完全缓解（P=0.999）；然而，17%的 ITP 和 29%的 AHA 患者复发（P=0.443）。复发后，64%的患者再次缓解，完全缓解率为 85%（ITP 为 82%，AHA 为 93%，P=0.427）。30 天和长期并发症发生率分别为 10%和 5%。无脾切除术相关 30 天死亡率。