The Position Of Splenectomy For Treating Idiopathic Thrombocytopenic Purpura

Idiopathic thrombocytopenic purpura is a immune syndrome,the bloodplatelet is destroied for the immunizing reasons .The spleen is the organwhere the platelet associated immunoglobulin produce and is the placewhere the blood platelet is destroyed.So the splenectomy can treat theIdiopathic thrombocytopenic purpura.Objective: Take a retrospective analyzing to find the curativeeffect of the splenectomy for treating idiopathic thrombocytopenicpurpura.Methods: We take a retrospectively follow-up visit for 44splenectomized ITP patients from February 1992 to July 2000,and thenanalyze 25 splenectomized ITP patients who we can get the information.Theage of these patients range from eleven to sixty-two,they have seven manand eighteen women .We get the message of the cure rate,the excellentrate,the effective rate,the relapse rate of five years by the follow-upvisit and the retrospective analyzing.We observe the message of sex,age,length of course,the number of the megacaryocyte,the effect ofglucocorticoid,the effect of immune globulin,the platelet counts beforeoperation,the condition of increase of platelet counts after theoperation.Then we analyze the relationship between these factors and thecurative effect of the splenectomy.The data have been analyzed byt-test,χ2test and rank sum test.Results: The therapeutic effect of the splenectomy for treatidiopathic thrombocytopenic purpura.There are 25 cases achieve long termfollow up.The curative cases is 15,the cure rate is 60%,20 cases is inexcellence,the excellent rate is 80%,the effective cases is 21,theeffective rate is 84%,the recurring cases in five years after operationis 4,the recurrence rate is 19%.The relationship between these factors and the curative effectof the splenectomy.1.There are seven man and eighteen women in the25 cases.There is not significant difference between male and femaleof the cure rate,the effective rate and the replase rate(P>0.05).2.The age of these patients range from 11 to 62yr(Average:32.12±12.52yr).There is no significant difference between A group(age≥45yr)and B group(age<45yr) of the cure rate,the effective rate and the re-cplase rate(P>0.05).3.The length of course range from 5 days to 11years.There is no significant difference between A group(course≥2yr)and B group(course<1yr) of the cure rate,the effective rate and thereplase rate(P>0.05).The course between the replase cases and thenon-replase caseshas no significant difference(P>0.05).4.There is nosignificant difference between A group(newly originated ITP casesbefore operation)and B group (relapsed ITP cases be-fore operation)of the cure rate,the effective rate and the replaserate(P>0.05).5.The number of the megacaryocyte has no significant difference in thefollow groups:curative group and uncured group,excellent group andnon excellent group,relapsing group and group of no-relapse.6.The ef-fect of glucocorticoid for ITP has no relationship with the cure ra-te,excellent rate of the splenectomy.7.The effect of immune globuli-n treatment has no relationship with the cure rate,excellent rateof splenectomy. In the effective immune globulin treated group sixcase(75%)did not relapse.8.The platelet counts before operation haveno significant difference in the follow groups:curative group and un-cured group,excellent group and non excellent group,relapsing groupand group of no-relapse.9.The time of the increase to normal of plat-elet count after the operation have no significant difference inthe follow groups:curative group and uncured group,relapsing groupand group of no-relapse.The cases whose platelet count increse to no-rmal in four days after operation has no relationship with the rela-pse rate.10.All the 25 cases do not have any post-operative compli-cations such as hemorrhage,infection,fluidify,thrombus,OPSI.11.Thedeath rate is 4%, one patient died in the first year after the opera-tion.Conclusions:1.The therapeutic effect of the splenectomy fortreat idiopathic thrombocytopenic purpura is good ,the cure rate is60%,the excellent rate is 80%,the effective rate is 84%.2.The relaps-e rate(five years) of the splenectomy for ITP is 19% which is lowerthan the relapse rate(72.2%) of the pure glucocorticoid treat forITP.3.The post-operative complications and the death rate of thesplenectomy for ITP are low.4.All of the sex,age,length of course,the number of the megacaryocyte,the effect of glucocorticoid,theeffect of immune globulin,the platelet counts before operation,thecondition of increaseof platelet counts after the operationa,have norelationship with the therapeutic efficacy of the splenectomy forITP.5.The good effect of glucocorticoid for ITP can hints that thetherapeutic efficacy of the splenectomy for ITP is good. 6.The infec-tion prevention is important for the prevention of the relapse andthe post-operative complications of ITP.