腹腔镜与开腹脾切除术治疗特发性血小板减少性紫癜的护理

目的探讨腹腔镜与开腹脾切除术治疗特发性血小板减少性紫癜（ITP）的护理异同。方法对比分析我科1996年10月—2008年9月在腹腔镜脾切除术（LS）的病例72例及同期行开腹脾切除术（OS）的病例50例，比较两组患者术后恢复情况的相关指标。结果腹腔镜组的平均手术时间明显长于开腹组（P〈0．05），术中出血量、腹腔引流量、术后疼痛程度、排气时间、术后进食时间、术后离床活动时间以及术后住院时间均低于开腹组（P〈0．05），两组术后并发症发生率、疗效及体温变化差异均无统计学意义（P〉0．05）。结论LS治疗ITP的疗效与OS相近，而且创伤小、恢复快、并发症发生率低，总结两种脾切除术临床护理的异同点，对提高腹腔镜脾切除术围手术期护理质量，促进患者康复具有重要的意义。

Nursing of idiopathic thrombocytopenic purpura treated with laparoscopic splenectomy and open splenectomy

Objective To compare the similarities and the differences of nursing care on patients with idiopathic thrombocytopenic purpura. Underwent laparoscope splenectomy and open splenectomy. Methods A total of 122 cases admitted from October 1996 to September 2008 were selected and investigated prospectively.Among them, 72 cases were underwent laparoscope spleneetomy, the other 50 cases were accepted open splenectomy. Indexes of the recovery after operation were compared. Results The mean operation time was longer in the laparoscopic splenectomy group than that in the open group ( 135.3 min vs 108.5 min,P ＜0. 05).The laparoscopic group decreased more significantly than the open group in blood loss ( 110 ml vs 185 ml),abdominal drainage volume ( 100 ml vs 230 ml), the off-bed ambulation time(26. 2 h vs 46.9 h), the anal aerofluxus time(28.9 h vs 68. 1 h) ,food intake time(32. 2 h vs 72.3 h), and post operative hospitalization (8.5 d vs 15. 1 d). Postoperative pain was significantly less in LS group ( P ＜ 0. 05 ). There were no differences in postoperative complication, treatment effectiveness and temperature between two groups (P ＞ 0. 05 ).Conclusions Laparoscope splenectomy, whereas of less traumatic and low morbidity, results in comparable effects as open splenectomy for the treatment of idiopathic thrombocytopenic purpura.. It has important significance to know both similarities and differences of clinical nursing care for patients undergoing the two ways of splenectomy, in order to enhance the nursing quality for peri-operative patients with splenectomy via laparoscope and promote their postoperative rehabilitation.