慢性 ITP の脾摘に対する術前γ-グロブリン大量静注療法

概要

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We have performed splenectomy in 26 children with chronic idiopathic thrombocytopenic purpura (ITP). Immediately before splencetomy, high dose intravenous gammaglobulin (HDIVG) was given in 8 patients (IVG group) and HDIVG was not given in 18 patients (N-IVG group). The age of IVG group was 11.4 ± 3.2 years and older children were more frequently found in this group (vs 7.9 ± 3.6 years in N-IVG group) (p<0.025). Platelet count (x10^4/mm^3) was 18.0 ± 11.4 in IVG group and 3.2 ± 3.5 in N-IVG group. In IVG group, significant rise in platelet count was seen (p<0.005). Experience of the surgeons in IVG group was 7.4 ±1.7 years and 9.6±7.0 years in N-IVG group. There was no significant difference. Blood loss (ml/kg), however, was 1.9 ±1.6 in IVG group and 9.7 ± 5.2 in N-IVG group. Fewer blood loss was recognized in IVG group (p<0.005). In treatment for ITP HDIVG is effective not only to defer or reduce needs of splenectomy but also to hematologically prepare before splenectomy and leads us an easy control of blood loss in operation. The side effects of HDIVG are deniable but the therapy costs. HIDIVG therapy have altered splenectomy for ITP in both quality and quantity.
日本小児外科学会の論文
1991-12-20