Surgery Department, Hospital de Especialidades Centro Médico La Raza, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.
Education Division, Hospital de Especialidades Centro Médico La Raza, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.
Clin Rheumatol. 2018 Apr;37(4):943-948. doi: 10.1007/s10067-018-3979-4. Epub 2018 Jan 16.
The objective of the study is to analyze the efficacy and safety of splenectomy in the management of refractory autoimmune thrombocytopenia (AT)/autoimmune hemolytic anemia (AIHA) associated or not with systemic lupus erythematosus. Thirty-four patients after splenectomy due to severe AT and/or AIHA were divided into group 1 (G1) 18 SLE/APS patients: 9 AT/SLE patients, 6 SLE/antiphospholipid syndrome (APS), and 3 primary APS. Group 2 (G2): 16 patients without SLE/APS: 2 Fisher-Evans syndrome and 14 AIHA. Surgery approach when (1) platelets ≤ 50,000/ml despite 2 weeks on medical therapy, (2) medically dependent, and (3) medically intolerant or after two hemolytic crises in AIHA patients. Splenectomy response: (1) complete (CR): ≥ 150,000 platelets/ml, (2) partial: 50,000-149,000/ml, or (3) none: ≤ 50,000/ml. CR for AIHA: hemoglobin ≥9 g/dl.
descriptive statistics and chi-square test. The mean age was 34.6 years; mean follow-up: 28.5 months. Open splenectomy in 15/34 vs laparoscopy in 19/34 (p = NS). CR in 15/34, G1: 4/18, G2: 11/16, (p = 0.006). Complications in 6/34, 5 from G2 vs 1 from G1 (p = 0.05). Relapse in 7/18 patients in G1 and 3/16 in G2 (p = 0.05). Open and laparoscopic splenectomies in SLE and AT patients are as effective as in those without SLE; however, patients with SLE and APS had more relapses.
分析脾切除术治疗伴有或不伴有系统性红斑狼疮（SLE）的难治性自身免疫性血小板减少症（AT）/自身免疫性溶血性贫血（AIHA）的疗效和安全性。
34 例因严重 AT 和/或 AIHA 而行脾切除术的患者分为两组：18 例 SLE/抗磷脂综合征（APS）患者为组 1（G1），其中 9 例为 AT/SLE 患者，6 例为 SLE/抗磷脂综合征，3 例为原发性 APS；16 例无 SLE/APS 患者为组 2（G2）：2 例 Fisher-Evans 综合征，14 例 AIHA。手术指征为：（1）尽管接受了 2 周的药物治疗，但血小板仍≤50000/ml；（2）药物依赖；（3）药物不耐受或 AIHA 患者发生 2 次溶血危象后。脾切除术后反应：（1）完全缓解（CR）：血小板≥150000/ml；（2）部分缓解：50000-149000/ml；（3）无缓解：血小板≤50000/ml。AIHA 的 CR 定义为血红蛋白≥9g/dl。
统计分析：描述性统计和卡方检验。患者平均年龄为 34.6 岁，平均随访时间为 28.5 个月。15/34 例患者行开放性脾切除术，19/34 例患者行腹腔镜脾切除术（p=NS）。34 例患者中有 15 例获得 CR，G1 组为 4/18，G2 组为 11/16（p=0.006）。G2 组发生 6 例并发症，均来自于 G2 组（p=0.05）。G1 组有 7 例患者复发，G2 组有 3 例患者复发（p=0.05）。SLE 合并 AT 患者的开放性和腹腔镜脾切除术与无 SLE 患者同样有效，但 SLE 合并 APS 的患者复发率更高。
