原位二级脾蒂离断法腹腔镜脾切除术治疗特发性血小板减少性紫癜

目的 探讨原位二级脾蒂离断法腹腔镜脾切除术(laparoscopic spleneetomy,LS)治疗特发性血小板减少性紫癜(idiopathic thrombocytopenia purpura,ITP)的可行性及临床疗效.方法 对41例ITP患者在腹腔镜下采用解剖二级脾蒂的方法,超声刀切开脾蒂浆膜,自下而上沿脾脏逐支分离脾动、静脉的二级分支,Hem-O-lok结扎夹钳夹2道,在两结扎夹之间用超声刀离断,切除脾脏.结果 41例患者均完成LS,无1例中转开腹.手术时间75～180 min,术中出血量50～800 ml.术中发现并切除副脾7例,2例患者术中脾蒂改为Endo-GIA切割离断.住院时间4～9 d,无严重并发症.术后血小板明显上升,5～7 d到达高峰.随访3～20个月,总有效率达到85.4%(35/41).结论 原位二级脾蒂离断法LS治疗ITP)安全有效、创伤小、并发症少、恢复快、手术费用低,值得临床推广.

Laparoscopic splenectomy by dissecting in situ secondary braches of splenic pedicle for idiopathic thrombocytopenic purpura:report of 41 patients

Objective To evaluate the feasibility and clinical efficacy of amputation in situ secondary braches of splenic pedicle for laparoscopic splenectomy(LS)in patients of idiopathic thrombocytopenic purpura(ITP).Methods LS was performed in 41 ITP patients hospitalized in our department from January 2007 to November 2008 by dissecting secondary braches of splenic pedicle.The serosa on the spleen pedicle was opened by using a harmonic scalpel.Then secondary structures of the splenic arteries and veins,one by one,w...