Yamada T, Takagi M, Miyagawa N, Shibata R, Hashiyada H, Kugimiya T
Department of Cardiovascular Surgery Nagasaki University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Sep;44(9):1809-13.
A 57-year-old female with valvular heart disease and chronic idiopathic thrombocytopenic purpura (ITP) underwent successful open-heart surgery. Preoperative administration of steroids and high-dose gamma-globulin increased the platelet count from 3 x 10(4)/microgram at admission to 10 x 10(4)/microgram before the operation. Splenectomy followed by mitral valve replacement (SJM 27M) were performed simultaneously. No platelet transfusion needed during and after the operation owing to rapid increase in platelets that would occur following splenectomy. The postoperative course was uneventful. The present simultaneous splenectomy and open-heart operation appears to be a safe and effective procedure for minimizing perioperative blood loss in patients with ITP and heart disease.
一名患有心脏瓣膜病和慢性特发性血小板减少性紫癜（ITP）的57岁女性成功接受了心脏直视手术。术前给予类固醇和大剂量丙种球蛋白使血小板计数从入院时的3×10⁴/微升升至手术前的10×10⁴/微升。同时进行了脾切除术和二尖瓣置换术（SJM 27M）。由于脾切除术后血小板会迅速增加，手术期间及术后无需输注血小板。术后病程平稳。目前这种同时进行脾切除术和心脏直视手术的方法似乎是一种安全有效的手术，可将ITP和心脏病患者围手术期的失血降至最低。
