An 18-year review of open and laparoscopic splenectomy for idiopathic thrombocytopenic purpura

BACKGROUND: Laparoscopic splenectomy has become the preferred surgical procedure for the management of idiopathic thrombocytopenic purpura (ITP). However, there studies have directly compared the incidence of recurrent ITP secondary to missed accessory spleens in open versus laparoscopic splenectomy. METHODS: Open and laparoscopic splenectomies performed for ITP at 4 sites over 18 years were analyzed. The incidence of recurrent disease secondary to missed accessory spleens was compared between the open and laparoscopic splenectomy groups. RESULTS: A total of 105 splenectomies (54 open/51 laparoscopic) were performed. Accessory spleens were identified in 6 laparoscopic and 6 open cases (P = .57). Recurrent disease occurred in 27.6% of open and 14.6% of laparoscopic cases (P = .222). There were no cases of recurrent ITP secondary to a missed accessory spleen in either group. CONCLUSIONS: The incidence of missed accessory spleens causing recurrent disease is similar when splenectomy is performed either open or laparoscopically.     

腹腔镜下脾切除术治疗特发性血小板减少性紫癜的临床应用研究(附15例报告)

目的:探讨腹腔镜下脾切除术的手术方法和治疗特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)的临床效果。方法:选择15例ITP患者在腹腔镜下完成脾切除术,比较手术前后的血小板计数。结果:15例均在腹腔镜下完成脾切除术,平均手术时间160min,术中平均失血50ml,术后平均住院8d,总有效率为94%。术后1周内血小板的反应率为100%。无死亡、出血等严重并发症发生。结论:ITP患者行腹腔镜脾切除术是安全可行的,手术效果满意。     

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura

BACKGROUND: Laparoscopic splenectomy (LS) has become the treatment of choice for patients with idiopathic thrombocytopenic purpura (ITP) who do not respond to medical treatment. Long-term follow-up data of LS for ITP are scarce. METHODS: From May 1997 to December 2002, we performed 67 LS for patients with ITP. Data were assessed retrospectively. RESULTS: LS was successfully attempted in all 67 patients. There was no surgical mortality. Three postoperative complications (5%) were encountered. The mean operative time decreased significantly from 176.2 minutes in the first 41 cases to 125.2 minutes in the last 26 cases. The mean postoperative hospital stay was 3.2 days. Accessory spleens were found in 3 patients (5%) during the LS. The mean follow-up interval was 23.3 months. The initial response to LS was 83%, and overall remission of ITP was 74%. The preoperative effect of steroid therapy had no significant influence on postoperative remission rate. More significant indicators of LS effectiveness were either an immediate postoperative platelet count surge or an immediate postoperative platelet count >or=100000/microL. CONCLUSIONS: LS can be performed safely with a satisfactory remission rate for patients with ITP who do not respond to medical treatment. Our results indicated that an immediate postoperative platelet count surge and/or an immediate postoperative platelet count >or=100000/microL were positive predictors of long-term remission after LS for ITP.     

腹腔镜脾切除术治疗难治性特发性血小板减少性紫癜

目的探讨腹腔镜脾切除术(laparoscopic splenectomy,LS)治疗内科药物治疗无效的难治性特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)的可行性和疗效. 方法回顾性分析1999年9月～2004年7月31例难治性ITP(血小板计数<50×109/L)行LS的临床资料.采用全麻、右侧斜卧位或完全右侧卧位、三孔法(27例)或四孔法(4例)进行手术. 结果 2例中转传统开腹手术.29例完成LS,手术时间为65 ～325 min,平均137 min.术中出血量50 ～600 ml,平均116 ml.6例术中发现副脾并切除.术后2例切口感染,1例切口皮下血肿.术后随访3～41个月,平均11个月,16例(55.2%)完全显效,8例(27.6%)部分显效,总有效率82.8%(24/29). 结论 LS治疗难治性ITP安全可行,效果良好.     

巨大副脾腹腔镜切除

目的报告1例巨大副脾的诊断和治疗经过,提示临床警惕巨大副脾的存在,减少误诊误治。注意副脾的血供多样性,减少术中出血。 方法回顾总结1例左上腹占位的患者资料,结合术前影像学检查、腹腔镜手术中探查所见,以及病理结果,完整记录诊治经过。 结果完成腹腔镜手术操作,术中妥善结扎巨大副脾的血管,没有出现其他副损伤;术后病理证实左上腹占位是副脾合并出血梗死。患者术后3 d治愈出院。 结论本例巨大副脾罕见,术前存在症状和体征,手术指征明确,微创治疗手段安全有效,效果满意。     

腹腔镜脾切除术治疗特发性血小板减少性紫癜

目的探讨腹腔镜脾切除术（laparoscopic splenectomy，LS）治疗特发性血小板减少性紫癜（idiopathic thrombocytopenic purpura，ITP）的疗效。方法头高左侧高位，常规四孔法。超声刀分离脾结肠韧带、脾胃韧带、脾肾韧带及脾膈韧带，其内血管用钛夹或Hem-o-lok结扎夹夹闭。内镜血管切割闭合器（Endo-Cutter）闭合切断脾蒂；或沿脾脏逐-分离、结扎、剪断脾动、静脉的分支，或分离出脾下极动脉和脾动静脉主干，7号丝线分别结扎，血管夹夹闭，逐-结扎、剪断其分支。脾脏放入标本袋，经扩大的trocar切口提出标本袋边，脾脏于标本袋内搅碎后取出。结果2例因术中出血中转开腹手术。26例完成LS，手术时间75～230min，平均121min；术中出血量20～350ml，平均89ml。5例发现副脾并切除。术后1～2d恢复饮食并下地活动。术后住院4～11d，平均5．3d。2例切口感染，1例切口皮下血肿，1例皮下气肿。26例LS随访2．5～62个月，平均20、5月，18例（69．2％）有效，4例（15．4％）部分有效，4例（15．4％）无效。结论LS治疗ITP安全可行、效果良好。     

Symptomatic pelvic accessory spleen

Accessory spleens are found most commonly at the splenic hilum, however, they rarely are symptomatic. An 18-year-old man presented with lower abdominal pain. Cross-sectional imaging studies with 3-dimensional reconstruction suggested the presence of a mass that was associated with the spleen. A nuclear medicine radioisotope scan confirmed that the mass was a pelvic accessory spleen. Laparoscopic excision was performed with excellent results. This accessory spleen was unusual in its size and location. Accessory spleens should be removed if symptomatic or if they are identified at splenectomy for hematologic disease.     

腹腔镜下脾切除治疗特发性血小板减少性紫癜的临床研究

目的 探讨腹腔镜脾切除术在治疗特发性血小板减少性紫癜中的应用,手术方法及临床效果。方法 对我科于1999年6月-2006年6月期间的24例7特发性血小板减少性紫癜在腹腔镜下行脾切除术进行回顾性分析。结果 本组24例腹腔镜脾切除术中,22例是顺利完成脾切除术,2例是分别由于术中脾蒂出血．胃短血管出血而中转开腹脾切除术。22例腹腔镜脾切除中,平均手术时间为150rain,术中平均失血量为100m1．术后胃肠蠕动恢复时间为10—24h,平均住院时间为4d。术后未发现有并发症。结论 腹腔镜脾切除术是治疗特发性血小板减少性紫瘢安全可行的最佳方法之一。     

特发性血小板减少性紫癜脾切除术后早期并发症

目的 评估脾切除治疗特发性血小板减少性紫癜（ＩＴＰ）的安全性。方法 回顾分析了１６７例ＩＴＰ选择性脾切除术的术后早期并发症。结果 １４例（８．３８％）病人出现１７例次术后早期并发症;切口感染７例,腹腔大出血２例,颅内出血２例,膈下脓肿１例,肺感染１例,应激性高血糖反应４例。２例（１．２０％）术后并发颅内出血死亡。结论 选择性脾切除术是ＩＴＰ一种安全的治疗手段。     

腹腔镜脾切除治疗特发性血小板减少性紫癜九例体会

目的：探讨腹腔镜脾切除在特发性血小板减少性紫癜中的应用。方法回顾性分析2008年1月至2010年6月传统手术组13例,2010年6月至2012年1月腹腔镜脾切除组9例的临床资料。采用SPSSl3．0统计软件进行数据分析,组间比较用χ2检验,P ＜0．05被认为有统计学意义。结果腔镜组切除脾脏时间平均80 min,传统手术组平均75 min,两组差异无统计学意义（χ2＝0．79, P＞0．05）。腹腔镜组术中出血量平均130 ml（50～280 ml）,传统手术组平均210 ml （60～450 ml）,腹腔镜组术中出血量明显少于传统手术组（χ2＝25．79,P＜0．05）;术后腹腔镜组24～48 h内恢复胃肠蠕动,传统手术组48～96 h ,平均72 h（χ2＝194．03,P＜0．01）;平均住院时间腹腔镜组6．5 d明显少于传统手术组12．8 d,（χ2＝87．88,P＜0．01）,以上数项差异均有统计学意义。术后随访6～48个月,腹腔镜组患者临床治愈率77．8％,传统手术组患者临床治愈率76．9％（χ2＝0．02,P＞0．05）,差异无统计学意义。结论腹腔镜脾切除治疗特发性血小板减少性紫癜安全可行,具有创伤小、恢复快等优点。     

术前血小板计数与腹腔镜脾切除术治疗特发性血小板减少性紫癜疗效的关系

目的探讨术前血小板计数与腹腔镜脾切除术（LS）治疗特发性血小板减少性紫癜（ITP）疗效的关系。方法回顾性分析98例有随访资料、经LS治疗ITP患者的临床资料,根据术前1d血小板（PLT）计数分为3组：Ⅰ组PLT计数〈50×10^9／L,Ⅱ组PLT计数在（50～100）×10^9／L,BI组PLT计数〉100×10^9／L。比较：,组间的手术结果指标及长期血液学疗效,定量资料比较采用单因素方差分析或秩和检验,定性资料比较采用X2或秩和检验。结果3组患者手术时间、术后48h引流量、术后第1天的PLT计数和术后住院天数的差异均有统计学意义（P〈0．05）。中位随访时间为34．5个月,其血液学疗效有明显差异（P=0．046）。结论ITP患者术前PLT计数与LS手术结果和血液学疗效有密切关系。术前应尽量提升PLT计数,降低手术风险。     

Enlarged accessory spleen after splenectomy mimicking a pancreas tumor

IntroductionAn accessory spleen (AS), a common condition, is usually located in the hilar region of the spleen. ASs are not often large; however, after splenectomy, the initially inactive AS may become reactive and hypertrophic. Therefore, an AS can be misdiagnosed as a neoplastic tumor and removed unnecessarily. An undiagnosed abdominal mass located in the spleen site in a patient who has had a splenectomy must be managed carefully. Computed tomography (CT) scanning and magnetic resonance imaging (MRI) may provide useful information for the diagnosis, preventing unnecessary surgery.Case presentationHerein, we report the case of a 38-year-old female with an enlargement of AS after splenectomy that was misdiagnosed as a primary tumor of the pancreas and managed by a nonessential surgery.ConclusionAn AS should be added to the differential diagnosis of a pancreatic tail tumor for patients with prior splenectomy in order to avoid nonessential surgery to ensure the patient’s safety.     

腹腔镜治疗特发性血小板减少性紫癜中转开腹原因分析

目的:探讨腹腔镜脾切除术(laparoscopic splenectomy,LS)治疗特发性血小板减少性紫癜(idiopathic thrombocyto-penic purpura,ITP)的中转开腹原因。方法:回顾分析我院15例ITP患者行LS的临床资料,并结合5篇文献进行分析。结果:153例均行LS,11例中转开腹,6例为术中血管损伤,3例为创面出血,2例系脾动脉栓塞术后腹腔粘连。结论:术中血管损伤、创面出血为中转开腹手术的主要原因,脾动脉栓塞术后腹腔粘连者行LS亦不易成功。     

免疫性血小板减少性紫癜脾切除血液学疗效与脾脏细胞免疫异常的关系

目的探讨免疫性血小板减少性紫癜(ITP)脾切除血液学疗效与脾脏细胞免疫的关系。方法应用免疫组织化学技术,采用抗人CD3、CD4、CD8单克隆抗体和抗人S100多克隆抗体,分别检测33例脾切除有效(A组)和14例脾切除无效(B组)的ITP患者的脾脏组织标本CD3+细胞、CD4+细胞、CD8+细胞和S100+细胞的表达情况,对照组为12例因外伤性脾破裂行脾切除术的脾脏组织标本(C组)。显微镜下观察脾脏组织动脉周围淋巴鞘(PALS)中染色阳性细胞的百分数,并计算CD4+/CD8+比值。分析3组CD3+、CD4+、CD8+、S100+细胞百分数和CD4+/CD8+细胞比值的差异。结果 3组PALS中CD3+、CD4+细胞百分数差异均无统计学意义;A组CD8+细胞百分数高于B组(P=0.001)和C组(P0.01),而C组PALS中CD4+/CD8+比值分别高于A组(P=0.001)和B组(P=0.001);A组PALS中S100+细胞百分数高于B组(P=0.015)。结论 ITP患者脾脏细胞免疫存在异常。脾切除血液学疗效与脾脏细胞免疫异常有密切关系。     

腹腔镜脾切除治疗原发性血小板减少性紫癜(附8例报告)

目的:探讨腹腔镜脾切除术(LS)治疗原发性血小板减少性紫癜(ITP)的临床意义。方法:回顾分析8例LS治疗ITP的临床资料。结果:8例均治愈,无再发出血,血小板总数上升为7.8×109~29.1×109/L,1例5.1×109/L,经糖皮质激素治疗(15mg/d),3月后停药,1例脾窝积液,2例脾热,经抗炎对症治疗后14d痊愈。结论:LS治疗ITP是一种理想的治疗方法。     

Accessory spleens: preoperative diagnostics limitations and operational strategy in laparoscopic approach to splenectomy in idiopathic thrombocytopenic purpura patients

Aim The preoperative detection of accessory spleen (AS) is still a very important and serious problem. The aim of the study was to assess the reasons for failure and the long-term results of laparoscopic splenectomy (LS) in patients with idiopathic thrombocytopenic purpura (ITP).Method Fifty-eight ITP patients underwent LS between June 1998 and December 2002. There were 42 women and 16 men. Preoperatively, we performed computed tomography (CT) and sonography to evaluate the size of the spleen and possibly to recognize the presence of the accessory spleens, which were found preoperatively in three cases.Results Intraoperatively, ASs were found in the course of laparoscopy in six cases overall, three preoperatively false negative. During follow-up (median time 31 months), in three patients the low platelet count was recognized, respectively after 5 months and 1.5 and 1.8 years. In all those cases scintigraphy was performed and in one case the residual accessory spleen, missed both in preoperative examination and during laparoscopy, was revealed. In two other patients, in spite of thrombocytopenia, no residual spleens were found.Conclusion We conclude that the problem of accessory spleens can be managed by careful videoscopic examination of the abdominal cavity during splenectomy, while the use of preoperative imaging techniques in detection of accessory spleens is still limited by the insufficient sensitivity of the examination.     

腹腔镜脾切除术治疗特发性血小板减少性紫癜的临床应用

目的探讨腹腔镜脾切除术（1aparoscopics plenectomy,LS）治疗特发性血小板减少性紫癜（idiopathic thrombocytopenic purpura,ITP）的可行性及临床疗效。方法回顾性分析2007年10月至2009年2月间16例行LS治疗ITP的临床资料。结果本组治愈15例,无再发出血,血小板总数上升为（130-439．1）×10^9／L;部分有效1例。术后并发肺部感染1例,戳孔感染2例,发热2例,均行对症治疗后治愈。术后无死亡病例。随访4～12个月．无复发病例。结论LS治疗ITP是安全、可行的。疗效良好。     

特发性血小板减少性紫癜行腹腔镜脾切除术的临床体会

[摘 要] 目的 探讨腹腔镜脾切除术治疗特发性血小板减少性紫癜（idiopathic thrombocytopenic purpura,ITP）的安全性和可行性。方法 回顾性分析皖南医学院第一附属医院2014年6月至2017年6月期间收治的确诊ITP患者27例,按照手术方法不同分为两组：腹腔镜组行腹腔镜脾切除术,共17例;开腹组行开腹脾切除术,共10例。观察两组手术基本情况,比较两组手术时间、术中出血量、术后通气时间、术后脾窝引流管拔除时间、术后住院天数,以及术后第1、3、7天患者外周血血小板计数。 两组患者均顺利出院,术后第7天两组患者外周血血小板计数均大于100×10 9 /L。两组手术时间、结果 术中出血量、术后第1、3、7天外周血血小板计数,差异无统计学意义（P>0.05）。但腹腔镜组在术后通气时间、术后脾窝引流管拔除时间、术后住院时间均较开腹组明显缩短（P<0.05）。结论 腹腔镜脾切除术治疗ITP创伤相对小、术后恢复快,安全、可行,值得临床推广。     

Use of a laparoscopic hand-assist device for accessory splenectomy

Background The use of a laparoscopic hand-assist device may aid in the identification of accessory spleens (ASs) and provide similar benefits to a conventional laparoscopic procedure. A patient with previous splenectomy for immune thrombocytopenic pupusa (ITP) and recurrent thrombocytopenia is reported.Method A computed tomography scan and RBC scan identified several nodules consistent with ASs. Initial laparoscopic exploration could not identify all the ASs seen on preoperative imaging. A hand-assist device was placed and a total of five nodules of splenic tissue were identified without conversion to laparotomy.Results The patient had a brief and uncomplicated postoperative course with a return of platelet counts to 350,000 at 1-month follow-up.Conclusion We propose that in the scenario of recurrent ITP following laparoscopic splenectomy, repeat laparoscopy is the first step once an AS is identified by preoperative imaging. If the AS is not identified at laparoscopy, the insertion of a hand-assist device is an alternative to a full laparotomy.Poster presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Los Angeles, California, USA, March 2003