【摘要】：目的探討腹腔鏡脾切除術(shù)(LS)治療免疫性血小板減少性紫癜(ITP)的長期臨床療效及預(yù)測(cè)遠(yuǎn)期療效的指標(biāo)。方法回顧性分析2007年1月-2014年1月我院肝膽外科84例ITP患者行LS治療的臨床資料。結(jié)果術(shù)后隨訪12-96個(gè)月,平均(51±24)個(gè)月,術(shù)后并發(fā)癥發(fā)生率8%,無兇險(xiǎn)性脾切除術(shù)后感染(OPSI)及死亡患者。術(shù)后長期有效率(CR+PR)75.0%(63/84),無效率(NR) 25.0%(21/84)。Kaplan-Meier法評(píng)估術(shù)后1年、3年、5年、7年緩解率分別為82.1%、77.2%、72.1%、67.5%。比較有效組(CR+PR)與無效組(NR)之間的資料時(shí),單因素分析結(jié)果顯示年齡、對(duì)激素反應(yīng)、術(shù)前血小板計(jì)數(shù)、術(shù)后1周內(nèi)血小板計(jì)數(shù)峰值差異有統(tǒng)計(jì)學(xué)意義(P0.05)；而性別、手術(shù)時(shí)間、術(shù)中出血量、病程的差異無統(tǒng)計(jì)學(xué)意義(P0.05)；多因素分析僅術(shù)后1周內(nèi)血小板計(jì)數(shù)峰值是預(yù)測(cè)手術(shù)療效的獨(dú)立因素(P=0.001、OR=1.008、95%CI=1.004-1.013)。結(jié)論LS治療ITP安全、可行,長期緩解率高；術(shù)后1周內(nèi)血小板峰值可能是預(yù)測(cè)LS治療ITP遠(yuǎn)期療效的指標(biāo)。屬性不符
[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 鹵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
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.6

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 馮澤榮;腹腔鏡脾切除術(shù)的研究進(jìn)展[J];醫(yī)學(xué)文選;2002年06期

2 王奕,張浩,胡理明,陳萍,王躍東;腹腔鏡脾切除術(shù)治療特發(fā)性血小板減少性紫癜[J];中華外科雜志;2003年10期

3 李學(xué)明,李勇,徐小躍,劉逸,范麗萍,張敏;腹腔鏡脾切除術(shù)二例報(bào)告[J];江西醫(yī)學(xué)院學(xué)報(bào);2003年05期

4 印慨,鄭成竹,柯重偉,李際輝,華積德;腹腔鏡脾切除術(shù)治療原發(fā)性血小板減少性紫癜29例報(bào)告[J];中國實(shí)用外科雜志;2004年04期

5 鄭曉風(fēng),蔣飛照,張啟瑜;腹腔鏡脾切除術(shù)七例[J];中華肝膽外科雜志;2004年05期

6 彭和平,李永國,邵子力,盧海武,梁建中;腹腔鏡脾切除術(shù)治療特發(fā)性血小板減少性紫癜臨床應(yīng)用研究[J];血栓與止血學(xué);2005年03期

7 李學(xué)明;肖衛(wèi)東;鄧小榮;張榮艷;楊贛萍;;腹腔鏡脾切除術(shù)治療特發(fā)性血小板減少性紫癜(附14例報(bào)告)[J];江西醫(yī)藥;2007年04期

8 傅永清;周劍;裘華森;顧文揚(yáng);李寧;;腹腔鏡脾切除術(shù)治療特發(fā)性血小板減少性紫癜[J];中國中西醫(yī)結(jié)合外科雜志;2007年03期

9 劉強(qiáng);楊建青;褚光平;;腹腔鏡脾切除術(shù)治療特發(fā)性血小板減少性紫癜15例分析[J];中國內(nèi)鏡雜志;2007年11期

10 張校陽;宋院斌;;腹腔鏡脾切除術(shù)9例分析[J];臨床醫(yī)學(xué);2008年09期

相關(guān)會(huì)議論文 前10條

1 戴啟強(qiáng);王愛東;方哲平;;腹腔鏡脾切除術(shù)20例治療體會(huì)[A];2009年浙江省外科學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2009年

2 傅永清;周劍;顧文揚(yáng);裘華森;任燕燕;張U，

本文編號(hào)：2295490