腹腔镜脾切除对难治性ITP治疗的应用价值

目的探讨腹腔镜脾切除术(LS)治疗难治性特发性血小板减少性紫癜(ITP)的可行性和疗效。方法回顾性分析2 0 0 2年9月—2 0 0 6年3月1 8例难治性ITP(血小板计数<5 0×1 09/L)行LS的临床资料。结果1例中转传统开腹手术。1 7例完成LS,手术时间为5 2~1 7 2m in,平均9 2m in;术中出血量3 0~5 0 0mL,平均1 0 2mL。3例术中发现副脾并切除。术后1周内血小板上升,胃肠蠕动恢复时间为1 2~2 4 h,平均住院时间为8 d。发生并发症2例(腹壁静脉刺破出血)。1 7例随访2~3 7个月,1例复发。结论腹腔镜脾切除术治疗ITP是安全可行的,且临床疗效显著。

Application of laparoscopic splenectomy in treatment of refactory idiopathic thrombocytopenic purpura

Objective To investigate the safety and efficacy of laparoscopic splenectomy(LS) in treatment of refractory idiopatic thrombocytopenic purpura(ITP).Methods The clinical data of 18 patients with ITP underwent LS from 2002 to 2006 were analyzed retrospectively.Results One case was converted to open surgery.Seventeen patients successfully underwent LS.The mean operation time was 92(52-172)minutes,and intraoperative mean blood loss was 102(30500)mL.At operation an accessory spleen was found in 3 cases and it was excised.The platelet count was elevated rapidly in one week postoperatively,and peristalsis of alimentary tract recovered in 12 to 24 hours after operation in all cases.The mean hospitalization time was 8 days.Complication(puncture of abdominal wall caused bleeding) occurred in two cases.Seventeen patients were followed up for 2-37months,one patient relapsed.Conclusions LS is a relatively safe and effective measure for treatment of ITP.