腹腔镜脾切除术治疗特发性血小板减少性紫癜临床应用研究

目的探讨腹腔镜脾切除术治疗特发性血小板减少性紫癜(ITP)的手术安全性、可行性及临床疗效。方法1999年12月至2004年12月对30例ITP患者行腹腔镜脾切除术，并对其临床资料进行回顾性分析。结果30例ITp患者腹腔镜手术成功率达93．3％，2例中转开腹手术；平均手术时间130min，术中失血平均100ml。全组均于术后24h内恢复胃肠蠕动，术后6h可下床活动。平均住院时间4．5d。术后1周内血小板很快上升。治疗有效率达93．3％。发生并发症3例：2例皮下气肿，1例隔下积液。平均随访24个月，3例复发，总有效率为90％。结论腹腔镜脾切除术治疗ITP安全可行，且疗效显著，给ITP患者提供了新的微创治疗方法。

Clinical Application of Laparoscopic Splenectomy for Idiopathic Thrombocytopenic Purpura

Objective To investigate the safety and efficacy of laparoscopic splenectomy (LS) performed for idiopathic thrombocytopenic purpura (ITP) . Methods From December 1999 to December 2004, LS was performed on 30 cases with ITP were analyzed by retrospectively. Results The successful laparoscopic operation was 93.3% with 2 cases converted to open splenectomy. The average duration of surgery was 130 min,estimated average blood loss was 100 ml,and peristalsis of alimentary tract was recovered within 24 hours after operation in all cases. All patients could get out of bed within 6 hours postoperatively. The average hospi-talization was 4. 5 days. Complications were occurred in 3 cases,of which 1 case developed subdiaphragmatic fluid collectiom, and other 2 cases developed subcutaneous emphysema. The early postoperative platelet count showed an immediate rise in almost all patients with CR + PR of 93. 3% . After mean 24 months of follow-up, 90% of patients after LS had normal platelet counts,3 patients relapsed and are still undergoing medical therapy. Conclusion Laparoscopic splenectomy is safe and technically feasible, and offers a minimally invasive and effective therapy for ITP.