腹腔镜脾切除术治疗免疫性血小板减少性紫癜的长期随访研究

发布时间：2018-10-26 10:57

【摘要】：目的探讨腹腔镜脾切除术(LS)治疗免疫性血小板减少性紫癜(ITP)的长期临床疗效及预测远期疗效的指标。方法回顾性分析2007年1月-2014年1月我院肝胆外科84例ITP患者行LS治疗的临床资料。结果术后随访12-96个月,平均(51±24)个月,术后并发症发生率8%,无凶险性脾切除术后感染(OPSI)及死亡患者。术后长期有效率(CR+PR)75.0%(63/84),无效率(NR) 25.0%(21/84)。Kaplan-Meier法评估术后1年、3年、5年、7年缓解率分别为82.1%、77.2%、72.1%、67.5%。比较有效组(CR+PR)与无效组(NR)之间的资料时,单因素分析结果显示年龄、对激素反应、术前血小板计数、术后1周内血小板计数峰值差异有统计学意义(P0.05)；而性别、手术时间、术中出血量、病程的差异无统计学意义(P0.05)；多因素分析仅术后1周内血小板计数峰值是预测手术疗效的独立因素(P=0.001、OR=1.008、95%CI=1.004-1.013)。结论LS治疗ITP安全、可行,长期缓解率高；术后1周内血小板峰值可能是预测LS治疗ITP远期疗效的指标。属性不符
[Abstract]:Objective to investigate the long term clinical effect of laparoscopic splenectomy (LS) in the treatment of immune thrombocytopenic purpura (ITP). Methods the clinical data of 84 ITP patients treated with LS from January 2007 to January 2014 were analyzed retrospectively. Results the postoperative follow-up was 12-96 months (mean 51 卤24) months. The incidence of postoperative complications was 8. There was no risk of (OPSI) infection and death after splenectomy. The long-term effective rate of (CR PR) was 75.0% (63 / 84), the ineffective rate of (NR) was 25.0% (21 / 84). The remission rates of 1 year, 3 years, 5 years and 7 years after operation by Kaplan-Meier were 82.1% and 77.2% respectively. 67.5. When comparing the data between (CR PR) and (NR) in the effective group, the results of univariate analysis showed that there were significant differences in age, response to hormone, platelet count before operation and peak value of platelet count within 1 week after operation (P0.05). However, there was no significant difference in sex, operative time, intraoperative bleeding volume and course of disease (P0.05). Multivariate analysis showed that the peak value of platelet count was an independent factor in predicting the outcome of the operation only one week after operation (P0. 001 OR 1.008 ~ 95 CI = 1.004-1.013). Conclusion LS is safe and feasible in the treatment of ITP with high long-term remission rate, and the peak value of platelet in one week after operation may be an index to predict the long-term effect of LS in the treatment of ITP. Attribute discrepancy
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.6

【相似文献】