背景:出血可能会干扰视野,并在执行预期的治疗时造成困难,特别是在涉及小工作空间的手术中,如内窥镜脊柱手术。因此,降低手术前出血的风险很重要。
方法:一名76岁女性,有3年沿L3皮刀的右大腿前疼痛史,在L3压缩骨折之后。此外,患者在50岁时发展为自身免疫性肝炎,实验室采血血小板计数为78×109/L
方法:磁共振(MR)图像显示L3-4水平的孔变窄。L3神经阻滞有效。怀疑L3椎间孔狭窄。
方法:由于可能的L3神经根压迫,计划采用显微内镜椎板切除术(MEL)进行椎间孔减压。Lusutrombopag,血小板生成素(TPO)受体激动剂,术前7天开始口服给药7天,以解决出血风险。
结果:患者成功接受MEL治疗,无任何不良事件或并发症。
结论:使用lusutrombopag获得的结果表明,可以在术前实施安全措施,lusutrombopag可能是肝硬化和血小板减少症患者微创治疗的有用补充药物。
BACKGROUND: Bleeding may interfere with the visual field and create difficulties in performing the intended treatment, especially in operations involving a small working space such as endoscopic spinal surgery. Therefore, it is important to reduce the risk of bleeding before surgery.
METHODS: A 76-year-old female presented with a history of right anterior thigh pain along the L3 dermatome for 3-years, following a L3 compression fracture. In addition, the patient had developed autoimmune hepatitis at 50 years of age, and the platelet count on laboratory blood collection was 78 × 109/L.
METHODS: Magnetic resonance (MR) images showed a narrowed foramen at the L3-4 level. L3 nerve block was effective. L3 foraminal-stenosis was suspected.
METHODS: Micro-endoscopic laminectomy (MEL) for foraminal decompression was planned due to possible L3 nerve root compression. Lusutrombopag, a thrombopoietin (TPO) receptor agonist, was orally administered for 7 days starting 7 days preoperatively to address the risks of bleeding.
RESULTS: The patient successfully underwent MEL without any adverse events or complications.
CONCLUSIONS: The results obtained from the use of lusutrombopag suggested that safety measures could be implemented preoperatively, and that lusutrombopag may be a useful supplemental drug for minimally invasive treatment of patients with cirrhosis and thrombocytopenia.