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。

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura

Objective To investigate the efficacy of laparoscopic splenectomy(LS) in the treatment of idiopathic thrombocytopenic purpura(ITP).Methods Clinical data of 28 cases of ITP undergoing LS from July 2000 to October 2005 were analyzed retrospectively.The patients were maintained at a left lateral elevated decubitus position.A routine 4-port laparoscopy was performed.The splenocolic ligament,gastrosplenic ligament,splenorenal ligament,and lienophrenic ligament were disconnected using a harmonic scalpel,with blood vessels closed with titanium clips or Hem-o-lok ligation.The pedicle of spleen was severed either by using the Endo-Cutter or according to routine ligation and dissection.The excised spleen was fragmented into pieces in a bag and removed through an extended trocar incision.Results Conversions to open splenectomy were required in 2 cases because of intraoperative massive bleeding.The LS was successfully accomplished in 26 cases,with an operative time of 75~230 min(mean,121 min) and estimated intraoperative blood loss of 20~350 ml(mean,89 ml).An accessory spleen was found and then removed in 5 cases.The patients got out of bed and took food within 2 postoperative days.The length of postoperative hospitalization was 4~11 d(mean,5.3 d).There were 2 cases of wound infection,1 case of incisional subcutaneous hematoma,and 1 case of subcutaneous emphysema.Follow-up in the 26 cases for 2.5~62 months(mean,20.5 months) showed 18 cases of complete response(69.2%),4 cases of partial response(15.4%) and 4 cases of failure of response(15.4%).Conclusions Laparoscopic splenectomy is a safe,feasible,and effective measure for the treatment of idiopathic thrombocytopenic purpura.