部分脾栓塞术联合脾动脉灌注长春新碱治疗难治性血小板减少性紫癜和Evans综合征的长期疗效

摘要

目的 观察部分脾栓塞术联合脾动脉灌注长春新碱治疗难治性血小板减少性紫癜(ITP)和Evans综合征的长期疗效.方法 对2000- 2007年收治的24例难治性ITP和6例Evans综合征患者行部分脾栓塞术治疗,并在栓塞前给予脾动脉灌注长春新碱(2 mg),观察长期疗效.结果 术后1周,ITP患者血小板从术前(10.23 ± 8.28) × 109/L升至(140.28 ± 85.45) × 109/L.Evans综合征患者血小板从术前(12 ± 8) × 109/L 升至(210 ± 60) × 109/L ;血红蛋白也不同程度升高[从术前(63.00 ± 13.62)g/L升至(123.00 ± 13.14)g/L].治疗有效率为100%.随访3 ～ 5年,30例患者中11例复发,其中术后6个月复发3例,2年复发6例,3 ～ 5年复发2例,复发率为36.7%,总有效率为63.3%.结论 部分脾栓塞术联合脾动脉灌注长春新碱治疗难治性ITP和Evans综合征长期效果肯定.%Objective To observe the long-term efficacy of partial spleen embolization combined with vincristine infusion in treating refractory idiopathic thrombocytopenic purpura (ITP) and Evans syndrome.Methods During the period of 2000 - 2007, partial spleen embolization together with vincristine infusion was carried out in 30 patients with refractory idiopathic thrombocytopenic purpura (n = 24) or Evans syndrome (n = 6). Vincristine infusion (2 mg) via splenic artery was performed before partial spleen embolization procedure. The long-term effectiveness was observed and analyzed. Results One week after the treatment. the platelet count was increased from preoperative (10.23 ± 8.28) × 109/L to (140.28 ± 85.45) ×lO9/L in patients with ITP, while the platelet count was increased from preoperative (12 ± 8) × 109/L to (210 ± 60) × 109/L in patients with Evans syndrome. Meanwhile, the hemoglobin level showed an increase in different degrees, from preoperative (63.00 ± 13.62) g/L to postoperative (123.00 ± 13.14) g/L. The therapeutic effectiveness was lOO％. During the follow-up time lasting for 3-5 years. recurrence was seen in 11 patients (36.7％) and the overall efficacy rate was 63.3％. Conclusion For the treatment of refractory idiopathic thrombocytopenic purpura and Evans syndrome, partial spleen emholization combined with vincristine infusion carries reliable long-term efficacy. (J Intervent Radiol, 2011, 20 : 610-612)