脾自家移植術の研究 : II 臨床的検討:特に ITP に対して

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Overwhelming sepsis is the most serious postoperative complication in splenectomized patients. Recently splenic autotransplantation has been applied in patients with splenectomy in oder to preserve immunological functions. Since 1983, 16 patients with Idiopathic Thrombocytopenic Purpura (ITP) have been treated by partial splenic autotransplantation after splenectomy (PSA) in our department. This study was designed to investigate the clinical effect of PSA in these patients compared to 7 patinets with ITP on which total splenectomy (TS) was performed. PSA was done by the omental pouch technique and the implanted volume was approximately 30% of the original splenectomized spleen. Clinical course, platelet count, serum immunoglobulin level, mitogen response and lymphocyte subpopulation were studied. No serious infection was found in any patients postoperatively. Only a mild bleeding tendency was observed almost equally in both groups. The increase of platelet count in PSA was less than in TS during the first postoperative weeks, such like this phenomenon was recognized in mice as we reported in "Splenic Autotransplantation : I Experimental Study". We thought that it was not sign of recurrence of ITP but effect for preventing in increase in the platelet count after splenic autotransplantation. In fact, no clinical problems was noticed in the PSA group. A decrease of serum IgM in PSA was less than TS during the postoperative 16 weeks. Stimulation index in mitogen response did not decrease and also lymphocyte subpopulation did not show any remarkable changes after PSA. Based on the results, it is considered that PSA is able to preserve some immunological function in patients with ITP as compared with those who had TS, and also that the regenerated spleen does not cause ITP after PSA.
特定非営利活動法人日本小児外科学会の論文
1990-02-20

脾自家移植術の研究 : II 臨床的検討:特に ITP に対して

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