血小板减少症患者施行泌尿外科手术围手术期管理(附12例报告)
Perioperative management of urological surgery in patients with thrombocytopenia(A report of 12 cases)
许晨 1唐文彬 2杨濛 2鲍一 2王军凯2
作者信息
- 1. 海军军医大学第二附属医院输血科(上海,200003)
- 2. 海军军医大学第二附属医院泌尿外科
- 折叠
摘要
目的:探讨血小板减少症患者接受泌尿外科手术的安全性和围手术期管理要点.方法:回顾性收集2018年8月-2022年2月于海军军医大学第二附属医院泌尿外科接受手术的血小板减少症患者12例.12例患者均行3级以上手术,其中5例行腹腔镜前列腺癌根治术,3例行经尿道前列腺剜除术,2例行腹腔镜肾部分切除术,2例行腹腔镜肾癌根治术.12例患者均术前连续应用重组人血小板生成素(recombinant human thrombocyo-poietin,rhTPO)皮下注射10～14 d,术前输注血小板,复查血常规血小板达到100× 109/L后施行手术治疗.术后继续应用rhTPO皮下注射5～7 d并监测血小板变化.并监测患者术前术后血红蛋白数值、凝血功能及术中出血、输血情况,并记录围手术期并发症情况.结果:12例手术均顺利完成.术中未出现术野明显渗血增加等情况.术后出血2例:肾部分切除术1例(术后第2天肾区引流管短时间内流出鲜红色引流液300 mL),前列腺剜除术1例(术后第2天膀胱冲洗出现大量鲜血,膀胱内形成血凝块),经输注红细胞悬液、血浆、冷沉淀、应用止血药等保守治疗后活动性出血停止,后恢复良好.其余患者无出血相关并发症.术后1个月复查血小板恢复到术前水平.结论:泌尿外科手术目前以微创为主,对于血小板减少症有着较高的耐受度.应用rhTPO和血小板输注提升血小板至正常水平后可以安全完成手术.受基础疾病影响,术后出血发生率相对较高,需要进行严密监测,积极处理.
Abstract
Objective:To investigate the safety and key points of the urological perioperative management of patients with thrombocytopenia.Methods:Twelve patients with thrombocytopenia were admitted to Department of Urology,the Second Affiliated Hospital of Navy Medical University from August,2018 to February 2022.All 12 patients underwent grade 3 surgery or above,including 5 cases with laparoscopic radical prostatectomy,3 cases with transurethral prostate enucleation,2 cases with laparoscopic partial nephrectomy and 2 cases with laparoscop-ic radical nephrectomy.Recombinant human thrombopoietin(rhTPO)was continuously injected to all 12 patients for consecutive 10-14 days before surgery.The patients also received platelet transfusion as well.Once the level of platelet reached 100×109/L,the urological surgery would be performed.After surgery,rhTPO was applied to patients through subcutaneous injection for 5-7 days and the change of platelet was monitored.The patient's pre-operative and postoperative blood hemoglobin value,intraoperative estimated blood loss,blood transfusion,and perioperative complications were recorded.Results:All of the 12 urological surgery procedures were successfully completed.There was no significant increase in intraoperative bleeding.Postoperative bleeding was occurred in 2 cases.In one case,300 mL blood was drained through drainage tube in renal area,2 days after partial nephrecto-my.In another case,blood clot and gross hematuria were observed 2 days after prostate enucleation.Following e-mergency treatments were given to these 2 patients:application of hemostatic and transfusion of red blood cell suspension,plasma and cryoprecipitate.Bleeding was stopped successfully through conservative treatment and the patients fully recovered without sequela.The other 10 patients had no bleeding-related complications.During postoperative follow-up,the level of platelet of all patients one month after surgery restored to that before surgery.Conclusion:The minimally invasive technique has been widely applied in urological surgery,which is characterized by less blood loss and hence give patients with thrombocytopenia better tolerance to bleeding.Surgery can be per-formed safely to these patients after the level of platelet restoring to normal level by applying rhTPO and platelet infusion.Affecting by the thrombocytopenia,the risk and incidence of postoperative bleeding is relatively high for these patients,which requires close monitoring and active treatment.
关键词
血小板减少/围手术期管理/泌尿外科Key words
thrombocytopenia/perioperative management/urology引用本文复制引用
出版年
2024
NETL
NSTL
万方数据