Najean Y, Rain J D, Billotey C
Department of Nuclear Medicine, Hospital Saint-Louis, Paris, France.
Br J Haematol. 1997 Jun;97(3):547-50. doi: 10.1046/j.1365-2141.1997.832723.x.
The indication for splenectomy in chronic idiopathic thrombocytopenic purpura (ITP) remains a controversial subject. The mortality rate of persistent thrombocytopenia is very low, except in severe cases. Conversely, the risks of splenectomy are significant (in the present series, morbidity: 4.1% mortality: 1.4%), with a success rate of only 60-75%. It is therefore useful to define a parameter able to predict the efficacy or failure of splenectomy. An analysis of 578 cases of chronic ITP, where the site of platelet destruction has been determined, is presented. 268 of these cases had been splenectomized. When platelet destruction was splenic, 96% of subjects aged 5-30 years and 91% of cases over the age of 30 years obtained a remission. Conversely, when platelet destruction was hepatic or diffuse, failure or incomplete results were observed in 92% of cases. The site of platelet destruction therefore constitutes a parameter which can help the clinician to make the decision to perform splenectomy.
在慢性特发性血小板减少性紫癜（ITP）中，脾切除术的指征仍是一个有争议的话题。持续性血小板减少症的死亡率很低，严重病例除外。相反，脾切除术的风险很大（在本系列中，发病率为4.1%，死亡率为1.4%），成功率仅为60 - 75%。因此，定义一个能够预测脾切除术疗效或失败的参数是很有用的。本文对578例已确定血小板破坏部位的慢性ITP病例进行了分析。其中268例已接受脾切除术。当血小板破坏发生在脾脏时，5 - 30岁的患者中有96%以及30岁以上的病例中有91%获得缓解。相反，当血小板破坏发生在肝脏或呈弥漫性时，92%的病例出现失败或不完全缓解的结果。因此，血小板破坏部位构成了一个有助于临床医生决定是否进行脾切除术的参数。
