部分脾栓塞术治疗儿童难治性免疫性血小板减少症的临床疗效观察

Clinical observation of partial splenic embolization on treating refractory immune thrombocytopenia for children

摘要:

目的：探讨部分脾栓塞术（Partial splenic embolization，PSE）治疗儿童难治性免疫性血小板减少症（Immune thrombocy－topenia，ITP）的临床疗效。方法：选择26例经内科治疗无效的儿童ITP患者，采用Seldinger技术，经股动脉插管，运用超选择性脾叶以下动脉栓塞法用明胶海绵颗粒行PSE，并于栓塞术后观察临床疗效。结果：栓塞术后1个月外周血小板计数（287.0±61.7）×109个/L，术后2年外周血小板计数（199.3±15.7）×109个/L。术前及术后血小板计数差异有统计学意义。有效病例血小板相关抗体下降，以PAIgG明显。临床症状明显改善，未出现严重并发症。结论：PSE是治疗儿童难治性ITP的一种微创、有效的方法，可替代外科脾切除，能保留脾脏的免疫功能，具有较好的临床应用价值。

Abstract:

Objective：To explore the clinical effect of partial splenic embolization（PSE） in treating refractory immune thrombocytope－nia（R-ITP） for children. Methods：26 cases of immune thrombocytopenia for children，which were ineffective with internal medicine，were performed with PSE through Seldinger technique via femoral artery with gelatin sponge by superselective sublobar arterial catheterization. Subsequently，the clinical effect and safety of the treatment on R-ITP for children after PSE were evaluated. Results：After one month the treatment by PSE，the counts of peripheral blood platelet were（287.0±61.7）×109 cells/L，while after two years the treatment by PSE，the counts of peripheral blood platelet were（199.3±15.7）×109 cells/L.There were significant difference in pre－operative and postoperative blood platelet counts.The blood platelet-associated antibodies of the effective cases had gone down，espe－cially，the distinct decline of PAIgG. Clinical symptoms improved obviously，no severe complications occurred in 26 cases. Conclu－sion：As a minimal invasive technique，PSE is a safe and effective method on treating R-ITP for children，it can take the place of operation and retain splenic immune function and has definite clinical value.