腹腔镜加小切口脾切除治疗原发性血小板减少性紫癜:附13例报告

目的　探讨腹腔镜加小切口行脾切除术治疗原发性血小板减少性紫癜 (ITP )的效果。方法　笔者采用腹腔镜加小切口辅助对 13例ITP患者进行脾切除手术。即用腹腔镜游离脾脏后 ,于左肋缘下作一小切口 ,直视下结扎脾蒂 ,切除和取出脾脏。分析手术前后患者的血小板计数、并发症率及术后恢复情况。结果　 13例术后均未发生并发症 ;ITP治疗有效率为 10 0 %。结论　腹腔镜加小切口脾切除术治疗ITP是一种安全有效的手术方法     

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。     

儿童脾切除的认识和体会

目的探讨有关儿童脾切除术前及术后的相关情况。方法回顾性分析了2001年4月至2004年9月脾切除患儿的资料,共有28例,其中男性16例,年龄最大14岁,最小15月,平均7．8岁,地中海贫血2例、球形红细胞增多症8例、脾肿大3例、ITP 10例、脾亢2例、外伤性脾破裂2例、门脉高压症1例,腹腔镜脾切除15例,开腹手术13例,急诊手术2例,择期手术26例。分别比较开腹组与腹腔镜组择期脾切除,通过）（2检验（P〈0．05）两者有显著差异。结果所有患者均顺利完成脾切除术,其中20例患者术后有不同程度的血小板计数升高,平均术后一周血小板升高至高峰。3例患儿有轻至中度的激素反应。腹腔镜组术后平均住院5d,天腹组术后平均住院10d。所有患者术后定期口服或肌注广谱抗菌素,随访1月～3年,无近、远期并发症,效期并发症,效果良好。结论儿童脾脏切除需要有一定的手术指征,术前应详细评估,术后应有效监测。腹腔镜下脾切除优点多值得推广。     

腹腔镜脾切除治疗特发性血小板减少性紫癜疗效及观测指标

目的：探讨腹腔镜脾切除(LS)治疗特发血小板减少性紫癜（ITP）的疗效。
方法：回顾分析采用腹腔境行脾切除治疗25例ITP患者的临床资料。
结果：所有ITP患者顺利施行LS,包括2例辅助小切口LS,无手术死亡、感染等严重并发症。平均随访3.5年（1～7年）,脾切除术后有效率80.0%（20/25例）,2年有效率72.0%（18/25例）,其中包括2例激素治疗出现胃溃疡大出血导致重度贫血及激素副作用的ITP患者。分析显示脾切除效果与患者年龄有关,≤50岁脾切效果明显优于>50岁的患者(P＜0.05)。术后随访发现脾切术后第7天血小板计数与术后2年复查血小板计数相一致,术后第7天平均血小板计数在脾切除有效者为307×109/L,明显高于脾切除无效的103×109/L（P＜0.05）。患者病程、激素治疗是否敏感、术前血小板计数均与脾切除疗效无关（P>0.05）。
结论：腹腔镜脾切除治疗特发性血小板减少性紫癜安全、可行并且有效,对年龄小于50岁、激素治疗无效或需大剂量激素治疗ITP患者宜积极行腹腔境脾切除术;脾切除时患者年龄、术后第7天血小板计数可能是判断脾切除效疗的有用指标。     

脾脏相关血液系统疾病的外科治疗

目的 探讨脾切除术(包括腹腔镜脾切除术)治疗某些血液病的手术指征、治疗效果及并发症的防治.方法 对27例因血液系统疾病行脾切除的病历资料进行回顾性分析.结果 遗传性球形红细胞增多症(HS,4例):有效率100%;特发性血小板减少性紫癜(ITP,17例):显效率 76.47%(13/17)非霍奇金淋巴瘤(NHL,6例):切除脾脏有益于其综合治疗.术后并发症的发生率为7.41%(2/27).结论 脾切除治疗HS疗效肯定,是HS首选的治疗方法.脾切除治疗大多数ITP有效,应选择好适应证.ITP病人对皮质激素治疗的反应并不一定影响脾切除的疗效.对于恶性淋巴瘤,脾切除可作为其综合治疗措施中的主要手段.选择好手术适应证,做好围手术期处理,有益于减少并发症的发生.     

脾切除治疗特发性血小板减少性紫癜69例体会

目的 探讨脾切除对内科治疗无效的特发性血小板减少性紫癜(idiopathic thrombocy-topenic purpura,ITP)的治疗效果.方法 对2000年5月～2008年4月经内科治疗无效在我科行脾切除术的69例ITP(其中6例附加副脾摘除术)的年龄、性别、术前病程、术前对激素的反应、术后血小板峰值与脾切除疗效进行统计学分析.结果 全部69例中,显效36例,良效18例,进步10例,无效5例,有效率(显效 良效)为78.3%.随访1年以上者57例,其中复发6例,复发率为10.5%.统计学分析显示术前对激素有反应者和术后血小板峰值较高者治疗效果较好(P<0.01),其余各项均无显著性差异.结论 脾切除术对内科治疗无效的难治性ITP病人是一种安全有效的治疗方法.     

腹腔镜脾切除术治疗血液系统疾病51例报告

目的：探讨腹腔镜脾切除术治疗血液系统疾病的可行性及效果。方法：应用腹腔镜脾切除术治疗经内科治疗无效或治疗后复发的原发性血小板减少性紫癜（idiopathic thrombocytopenic purpura,ITP）患者42例,遗传性球形红细胞增多症（hereditary spherocytosis,HS）患者9例。结果：本组51例无手术死亡及严重并发症发生,脾切除术后血液检测指标均明显改善,术后第7天ITP患者的血小板计数均值由23×109/L升为618×109/L;HS患者的网织红细胞均值由18%降至2.1%,血红蛋白均值由6.1g/L升至9.8g/L。结论：腹腔镜脾切除对部分血液系统疾病的治疗具有微创、安全、有效、美容效果好、术后患者康复快等优点,值得推广应用。     

小儿原发性血小板减少性紫癜脾切除术12例的麻醉处理

脾切除术是治疗小儿原发性血小板减少性紫癜(ITP)的措施之一。我院自1983年12月至1986年2月共对12例ITP患儿施行了脾切除术,现就麻醉处理和体会报告如下。一般资料本组男5例,女7例,年龄3～14岁。血小板计     

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。     

腹腔镜脾切除术治疗特发性血小板减少性紫癜

由于特发性血小板减少性紫癜(ITP)是血液病行脾切除最常见的指征。腹腔镜脾脏切除术(LS)术后胃肠功能恢复快，疼痛轻，并发症少，因此适用于ITP需行脾切除者。我们从2001年7月至2002年8月为16例ITP的患者行LS治疗，均取得成功。     

Splenectomy for idiopathic thrombocytopenic purpura: a five-year retrospective review

Idiopathic thrombocytopenic purpura is a condition that is characterized by persistently low platelet counts. Idiopathic thrombocytopenic purpura results from splenic sequestration and accelerated platelet destruction mediated by antiplatelet antibody. Most cases arise in previously healthy patients, mostly women ages 20 to 40. Clinical symptoms consist of bruising, petechiae, mucosal bleeding, menorrhagia, and intracranial bleeding. Platelet-associated immunoglobulin G can be detected in 90 per cent of patients. Therapy for adults and children is somewhat different. Splenectomy in adults should be considered in patients who fail to respond to steroids, develop thrombocytopenia after taper, or develop steroid toxicity. Ninety per cent of children will maintain normal platelet counts in 9 to 12 months. Some will recover spontaneously without medical therapy. Splenectomy in children is recommended if idiopathic thrombocytopenic purpura persists for more than one year or fails to respond to steroids. Our purpose was to determine whether management of idiopathic thrombocytopenic purpura in patients who undergo splenectomy at our institutions is appropriate and effective. We undertook a 5-year retrospective review of 27 patients with idiopathic thrombocytopenic purpura which have undergone splenectomy. All of the 27 patients were referred to surgeons after initial medical management. The patients were divided into two groups on the basis of length of therapy: longer than 6 months and less than 6 months. The longer than 6 months group contained 15 patients. This group had a postoperative complication rate of 40 per cent. Those in the group with <6 months therapy had a complication rate of 7 per cent. Average follow-up for all patients was 20 months. Eighty-eight per cent of the patients had complete response. Three per cent had a partial response with platelet counts >50,000. The partial response group did not respond well to preoperative steroid boluses with a great rise in platelet counts. Eighteen per cent of patients received platelet transfusions. Sixty per cent of the transfusions were given for inappropriate reasons. A large percentage of our patients had prolonged medical therapy before splenectomy. The inappropriate use of platelets was a common error in management. Patients treated for more than 6 months had more postoperative complications. An initial increase in platelets after steroid bolus is a good indicator for favorable response to splenectomy. We conclude that splenectomy is a safe and effective method of treatment for idiopathic thrombocytopenic purpura with no deaths or postsplenectomy sepsis to date.     

Correlation between response to corticosteroids and splenectomy for adult idiopathic thrombocytopenic purpura

Of 273 splenectomies performed over a six and a half year period, twenty-nine were performed for adult idiopathic thrombocytopenic purpura. Of the twenty-seven patients who received adequate preoperative corticosteroids, fifteen had a significant platelet elevation and these fifteen had an excellent response to splenectomy. Of the remaining twelve patients, eight had either an immediate or delayed response to splenectomy. One subsequently died from complications of idiopathic thrombocytopenic purpura.     

Splenectomy for idiopathic thrombopenic purpura. A retrospective study of 40 cases

The authors analysed retrospectively the files of 40 patients who underwent splenectomy for idiopathic thrombocytopenic purpura and who were totally or partially (relapse) resistant to a therapeutic trial of corticosteroids. There was no operative mortality but morbidity, especially respiratory, was substantial, being 40%. Drainage of the splenic bed should be avoided because this is clearly associated with a greater frequency of pulmonary complications. In 37 patients with a mean follow-up of 30.3 months, there was complete remission in 89.2% after splenectomy. This confirms the therapeutic value of splenectomy in idiopathic thrombocytopenic purpura, especially in those who showed a partial (transitory) response to corticosteroids.     

脾切除治疗原发性血小板减少性紫癜的临床观察

目的研究脾切除对原发性血小板减少性紫癜的治疗效果。方法对１９７４年～１９９６年内科治疗无效的６３例原发性血小板减少性紫瘢（ＩＴＰ）患者行脾切除手术并对其临床疗效进行观察。全组患者术后随访２个月至１６年,平均４．７年,其中随访半年以上者４８例。结果术前全部患者均有出血症状,血小板平均２４×１０９／Ｌ,术后１、３、５、７天血小板平均值分别上升为１１０×１０９／Ｌ、２０２×１０９／Ｌ、２５１×１０９／Ｌ和２４６×１０９／Ｌ,其中血小板一周内恢复正常（≥１００×１０９／Ｌ）者５１例,占８０．９％;术后２个月时血小板在正常范围者４５例,治愈率７３．８％,显效率１３．１％,总有效率为８６．９％。对３９例手术有效的病例长期随访,发现７例复发,复发率１７．９％。结论儿童组疗效略好于成人组,但差异无显著性意义;术前病程长短与手术疗效无相关关系;术后血小板回升较早及回升幅度较高者预后较好。观察患者术后骨髓像的改变可能是预测ＩＴＰ远期疗效的指标之一     

Coronary artery bypass in idiopathic thrombocytopenia without splenectomy

A patient with coronary artery disease and idiopathic thrombocytopenia purpura underwent coronary artery bypass grafting without splenectomy. Our experience indicates that use of cardiopulmonary bypass in patients with idiopathic thrombocytopenic purpura does not invariably mandate splenectomy.     

Laparoscopic splenectomy reduces the need for platelet transfusion in patients with idiopathic thrombocytopenic purpura.

OBJECTIVES: Laparoscopic splenectomy has been increasingly used in patients with idiopathic thrombocytopenic purpura. Because it is associated with minimal abdominal trauma, platelet consumption could be reduced with the laparoscopic approach. The aim of this study was to analyze intraoperative bleeding and the need for apheresis platelets, comparing laparoscopic with open splenectomy. METHODS: Records of 40 patients who underwent splenectomy (20 through laparoscopy and 20 through open surgery) for idiopathic thrombocytopenic purpura were retrospectively reviewed. Intraoperative bleeding and need of perioperative apheresis platelets were evaluated in both groups. Statistical evaluation was conducted using the Mann-Whitney rank test, and differences were considered significant at P<0.01. RESULTS: The mean amount of intraoperative bleeding was less in the laparoscopic group (P<0.01). Apheresis platelets were necessary in all patients in the open group (2 units transfused in 55% and 1 unit in 45% of cases) and only in 30% of cases in the laparoscopic group (1 unit transfused in each case). CONCLUSIONS: Laparoscopic splenectomy is a safe procedure also in patients at high risk for bleeding diathesis. In idiopathic thrombocytopenic purpura, laparoscopic splenectomy should be the gold-standard surgical treatment. Need of platelet transfusion is probably reduced when laparoscopic splenectomy is compared with open surgery in these patients.     

Splenectomy using a completely needlescopic procedure: report of three cases

BACKGROUND AND PURPOSE: Needlescopic instruments are being used in various fields of endoscopic surgery. We evaluated the safety and efficacy of laparoscopic splenectomy using a needlescope. PATIENTS AND METHODS: This procedure was performed in three patients, two women and one man, having idiopathic thrombocytopenic purpura that had not responded to medical treatment. Four ports (one 12 mm and three 2 mm in diameter) were introduced into the left upper quadrant. A 2-mm needlescope was used throughout the procedure. The spleen was divided from the splenocolic, splenophrenic, and splenorenal ligaments posterior to the splenic hilum. The splenic hilar and short gastric vessels were divided simultaneously using a linear stapler. The resected spleen was morcellated via the 12-mm port. RESULTS: The mean operation time was 167 minutes, and the mean estimated blood loss was 70 mL. No postoperative analgesia was needed by any of the patients, and there were no perioperative complications. The 2-mm postoperative scars were virtually invisible. CONCLUSION: Needlescopic splenectomy for idiopathic thrombocytopenic purpura is feasible and safe with less postoperative pain and a superior cosmetic result compared with conventional laparoscopic splenectomy.     

Aortic valve replacement in a patient with idiopathic thrombocytopenic purpura.

A patient with aortic regurgitation and idiopathic thrombocytopenic purpura underwent a successful valve replacement. Cardiac surgery requiring a cardiopulmonary bypass in idiopathic thrombocytopenic purpura can be safely carried out with the preoperative intravenous administration of high-dose gammaglobulin, which may thereby reduce the need for either perioperative transfusion or prophylactic splenectomy.     

Aortic valve replacement in a patient with idiopathic thrombocytopenic purpura

A patient with aortic regurgitation and idiopathic thrombocytopenic purpura underwent a successful valve replacement. Cardiac surgery requiring a cardiopulmonary bypass in idiopathic thrombocytopenic purpura can be safely carried out with the preoperative intravenous administration of high-dose gammaglobulin, which may thereby reduce the need for either perioperative transfusion or prophylactic splenectomy.