Department of General and Visceral Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, Building W1, D-48149 Muenster, Germany.
Department of General and Visceral Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, Building W1, D-48149 Muenster, Germany.
Int J Surg. 2014 Dec;12(12):1428-33. doi: 10.1016/j.ijsu.2014.10.012. Epub 2014 Oct 29.
Laparoscopic splenectomy has been proposed to be the standard therapy for adult patients with medically refractory immune thrombocytopenia (ITP). However, due to inconsistent definitions of response, variable rates of long term response have been reported. Furthermore, new medical treatment options are currently challenging the role of splenectomy. The aims of this study were to (1) analyze long term response after splenectomy according to recently defined consensus criteria, (2) identify possible predictive response factors.
A case series of 72 consecutive patients with ITP undergoing laparoscopic splenectomy was retrospectively studied using univariate and multivariate analysis as well as logrank tests.
Median follow-up was 32 (2-110) months. Mortality was 0% and morbidity was 8.2%. Response to splenectomy was achieved in of 63/72 patients (87.5%). Loss of response occurred in 19/63 (30.2%) in median after 3 (range 2-42) months. Preoperative platelet counts after boosting with steroids and immunoglobulins as well as the postoperative rise in platelet counts were statistically significant factors for response upon both univariate and multivariate analysis, whereas age, gender, body mass index, ASA classification, disease duration, accessory spleens, splenic weight, conversion to open surgery, or perioperative complications were not. Patients with a postoperative rise in platelet counts >150,000/μL had a significant better chance on stable long term response than those with a smaller increment (P < 0.001).
Laparoscopic splenectomy is an effective and safe treatment option in order to obtain stable long term response in patients with ITP. Perioperative platelet counts are predictive factors of long term response.
腹腔镜脾切除术已被提议作为成人药物难治性免疫性血小板减少症（ITP）患者的标准治疗方法。然而，由于反应的定义不一致，长期反应的发生率也存在差异。此外，新的医学治疗选择目前正在挑战脾切除术的作用。本研究的目的是：（1）根据最近定义的共识标准分析脾切除术后的长期反应，（2）确定可能的预测反应因素。
回顾性分析了 72 例连续接受腹腔镜脾切除术的 ITP 患者的病例系列，采用单变量和多变量分析以及对数秩检验。
中位随访时间为 32（2-110）个月。死亡率为 0%，发病率为 8.2%。63/72 例（87.5%）患者达到脾切除反应。中位数在术后 3（范围 2-42）个月时，19/63 例（30.2%）失去反应。术前类固醇和免疫球蛋白增强后的血小板计数以及术后血小板计数的升高是单变量和多变量分析中反应的统计学显著因素，而年龄、性别、体重指数、ASA 分类、疾病持续时间、副脾、脾重、转为开腹手术或围手术期并发症不是。术后血小板计数升高>150,000/μL 的患者比血小板计数升高较小的患者有稳定长期反应的机会明显更好（P<0.001）。
腹腔镜脾切除术是一种有效且安全的治疗选择，可使 ITP 患者获得稳定的长期反应。围手术期血小板计数是长期反应的预测因素。
