腹腔镜下脾切除术治疗特发性血小板减少性紫癜

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura

目的探讨腹腔镜下脾切除术治疗特发性血小板减少性紫癜的安全性和临床效果。方法回顾性分析2006年9月～2009年12月该院30例采用腹腔镜下脾切除术治疗特发性血小板减少性紫癜患者的临床资料。结果 30例患者均顺利完成腹腔镜下脾切除术,平均手术时间为(156.0±45.0)min,术中出血量为(120.0±65.0)mL,胃肠功能恢复时间为(22.0±10.8)h,术后平均住院时间为(9.0±5.6)d,总有效率达到93.3%;术后第1、3、5、7及14天血小板计数分别为(180.6±63.2)×109/L、(232.6±75.8)×109/L、(263.0±83.5)×109/L、(298.0±93.7)×109/L和(142.0±52.6)×109/L,与术前(31.6±13.0)×109/L相比,差异有显著性(P<0.01),术后并发腹腔脓肿1例,腹壁穿刺孔感染1例,均经非手术治疗治愈,全组无手术死亡。结论 LS治疗ITP安全可行,疗效满意,是一种较理想的治疗手段。

【Objective】To investigate the security and clinical curative effect of laparoscopic splenectomy （LS） in the treatment of idiopathic thrombocytopenic purpura（ITP）.【Methods】The clinical data of 30 patients with idiopathic thrombocytopenic purpura （ITP）,who underwent laparoscopic splenectomy （LS） from September 2006 to December 2009,were retrospectively analyzed.【Results】Laparoscopic splenectomy（LS） was successfully performed in all the 30 patients. The average operative duration was （156.0±45.0） min.The average intraoperative blood loss was （120.0±65.0） mL.The average gastrointestinal functional restoration time was （22.0±10.8）h.The postoperative average stay was （9.0±5.6） d. The total effective rate reached 93.3%.The thrombocyte count at the postoperative 1st,3rd,5th,7th,14th day was （180.6±63.2）×109/L,（232.6±75.8）×109/L,（263.0±83.5）×109/L,（298.0±93.7）×109/L and （142.0± 52.6）×109/L,respectively. Compared with the preoperative thrombocyte count （31.6±13.0）×109/L,there was statistically significant difference （P 0.01）. The occurred complications including intra-abdominal abscess in 1 case and puncture hole infection in abdominal wall in 1 case were cured by nonoperative therapy. No mortality existed. 【Conclusion】LS is a relatively ideal measure for ITP because of its safety and feasibility and satisfactory outcome.