Analysis Of Prognostic Factors For Splenectomy In Immune Thrombocytopenic Purpura

Objective:The paper is aimed to analyze the clinical features and effects ofpatients who performed splenectomy in our hospital so as to identify theprognostic factors after splenectomy for ITP.Methodology: We take a retrospective analyisis and follow-up visit forpatients who performed splenectomy because of ITP during2003-2011.Thecases were divided into effective group and ineffective group according to theeffect after operation. Then we compare the factors which may affect theprognosis between two groups by spss13.0and draw a conclusion.Results: There are74patients during statistic period.72cases are successful-y followed up, while the other two cases can not be contacted with for thereason that the addresses have changed. None of the patients beingfollowed-up has died. There are56LS patients and16OS patients. Two LSpatients turned to OS during operation because of serious adhesion betweenspleen and peripheral areas. One patient uses hand-assisted LS. The number ofcomplete response cases is41, which amouts to56.9%. The number ofresponse is15, and the rate is20.9%. The number of non-response is16, andthe rate is22.2%. The total effictive case ratio is77.8%. There are20malepatients(accouting for27.8%)and52female patients (accounting for72.2%)in the group. The ratio of men to women is1:2.6. The age of these patientsranges from8-72years old. The median age is34.5. There are31patients(accounting for43%) in none or mild hemorrage,30patients in moderate(accounting for41.6%) and11in wild hemorrhage (accounting for15.4%).By analyzing difference of the factors such as sex, age, duration of disease,pre-operative wbc count, size of spleen, severity of bleeding, preoperativeplatelet count, postoperative platelet count of1,3,5,7day, type and countof megakaryocyte, response to IVIG and steroids before splenectomy, dependence to oral steroids, max postoperative platelet count, postoperativeplatelet count and recovery rate between two groups, we found that there isstatistically significant difference between two groups concerning age,preoperative platelet count and the PCT, bone marrow megakaryocyte count,platelet count of POD1,3,5,7and PCT of POD1,max postoperativeplatelet count postoperative platelet count recovery rate(P<0.05).Besidesthat, no stastical difference is found between two groups concerning otherfactors.Conclusion:1,Spenectomy is an efficient way of treating ITP.2,The max-count of postoperative platelet appears at POD7usually.3,Course of disease, the severity of bleeding, the effect ofpreoperative oral steroids on the response to thepreoperative steoid and IVIG impact, preoperative bonemarrow the megakaryocyte classification, and preoperativeand first postoperative day, mean platelet volume (MPV),platelet distribution width (PDW), a large percentage ofimmature cells (LTC) have no effect on the prognosis.4,Patients with higher preoperative platelet count and PCT,high bone marrow megakaryocyte count, younger age,higher platelet count of POD1,3,5,7and PCT of POD1,high max postoperative platelet count and postoperativeplatelet count recovery rate may have a good prognosis.5,BMMT is the independent prognostic factor of response tosplenectomy in ITP.6,Different surgical methods do not affect the efficency, andthere is no difference in complications between LS groupand OS group. The LS has the characters of rapidpostoperative GI fanction recovery, shorter fever time, lessincision, tiny scar and better quality of life after operation.The shortcoming is a longer operation time, but with the increase of surgical proficiency, there will be no differencein the operation time with abdominal surgery.