腹腔镜脾切除术治疗难治性特发性血小板减少性紫癜

Laparoscopic splenectomy for refractory idiopathic thrombocytopenic purpura

目的 探讨腹腔镜脾切除术 (laparoscopicsplenectomy ,LS)治疗内科药物治疗无效的难治性特发性血小板减少性紫癜 (idiopathicthrombocytopenicpurpura ,ITP)的可行性和疗效。 方法 回顾性分析 1999年 9月～ 2 0 0 4年 7月 31例难治性ITP(血小板计数 <5 0× 10 9/L)行LS的临床资料。采用全麻、右侧斜卧位或完全右侧卧位、三孔法 (2 7例 )或四孔法 (4例 )进行手术。 结果 2例中转传统开腹手术。 2 9例完成LS ,手术时间为 6 5～ 32 5min ,平均 137min。术中出血量 5 0～ 6 0 0ml,平均116ml。 6例术中发现副脾并切除。术后 2例切口感染 ,1例切口皮下血肿。术后随访 3～ 4 1个月 ,平均 11个月 ,16例 (5 5 2 % )完全显效 ,8例 (2 7 6 % )部分显效 ,总有效率 82 8% (2 4 / 2 9)。 结论 LS治疗难治性ITP安全可行 ,效果良好。

Objective To investigate the feasibility and effectiveness of laparoscopic splenectomy (LS) in patients with refractory idiopathic thrombocytopenic purpura (ITP) resistant to medical management. Methods Clinical data of 31 cases of refractory ITP (platelet count < 50×10 9/L) undergoing LS between September 1999 and July 2004 were analyzed retrospectively. The patients were placed in right lateral semidecubitus or decubitus position. All the operations were performed under general anesthesia by using either three-port technique (27 cases) or four-port technique (4 cases). Results Conversions to traditional open surgery were required in 2 cases. LS was successfully conducted in 29 cases, with an operative time of 65～325 min (mean, 137 min) and an estimated intraoperative blood loss of 50～600 ml (mean, 116 ml). Accessory spleen was found and removed during the surgery in 6 patients. Postoperatively, there were 2 cases of wound infection and 1 case of incisional subcutaneous hematoma. Follow-up for 3～41 months(mean,11 mohths) showed 16 cases of complete response (55.2%) and 8 cases of partial response (27.6%), the total response rate being 82.8% (24/29). Conclusions Use of LS for refractory ITP is safe, feasible and effective.