腹腔镜脾切除术治疗特发性血小板减少性紫癜(附14例报告)

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura:reports of 14 cases

目的探讨腹腔镜脾切除术治疗特发性血小板减少性紫癜的安全性及临床疗效。方法回顾性分析我院2002年10月～2006年12月间14例特发性血小板减少性紫癜行腹腔镜脾切除术的临床资料。结果手术无中转,平均手术时间为152min,平均出血量为200ml。术中发现副脾1例(7.1%,1/14)。术后胃肠蠕动恢复时间为12～36h,术后平均住院时间为7d。发生手术并发症2例(14.3%,2/14),皮下气肿1例,左侧腹壁广泛淤斑1例。术后1周内血小板计数很快上升,平均峰值达284×109/L。随访2～51个月(平均21.6个月),根据疗效标准,显效7例,良效4例,进步1例,无效2例,总有效率为85.7%(12/14)。结论腹腔镜脾切除术是治疗特发性血小板减少性紫癜安全有效的方法。

Objective To evaluate the feasibility and efficacy of laparoscopic splenectomy （LS） for idiopathic thrombocytopenic purpura （ITP）. Methods The clinical datas of 14 cases with ITP undergoing LS from Oct 2002 to Dec 2006 were retrospectively analyzed.Results No conversion to open surgery occurred. The average operating time was 152 rain and blood loss was 200 ml.Accessory spleen was found in one patient （7.1%,l/14）.Postoperative GI movement started from 12 to 36 hours and the average postoperative hospital stay was 7 days. Postoperative complication occurred in 2 cases （14.3%,2/14）,including one subcutaneous emphysema and one left lateral abdominal wall diffuse ecchymosis. The platelet count was elevated rapidly and the average peak count reached to 284×10^9/Lin one week. These patients were follow-up for 2-51 months （averaged 21.6 months）with the total therapeutic response rate of 85.7%, Conclusion LS is a safe and effective therapy for ITP.