腹腔镜与开腹脾切除术治疗儿童特发性血小板减少性紫癜的疗效比较

Comparison of laparoscopic with open Splenectomy for Idiopathic Thrombocytopenic Purpura in children

目的探讨腹腔镜脾切除术（laparoscopic splenectomy，LS）和开腹脾切除术（open splenectomy，OS）治疗儿童特发性血小板减少性紫癜（idiopathic thrombocytopenic purpura，ITP）的临床疗效。方法2003年1月至2012年2月作者实施脾切除术治疗ITP30例，其中12例采取LS，为LS组；18例采取OS，为OS组。两组术后均随访3—36个月。结果30例患儿均成功实施脾切除术，LS组和OS组平均手术时间分别为140min、118min，术中平均出血量分别为26．67mL、43．18mL，术后平均恢复饮食的时间分别为2d、2．5d，术后平均住院时间分别为8．5d、11．5d。治疗有效率：LS组为91．67％（11／12），OS组为94．44％（17／18），术后1周LS组和OS组平均血小板分别升高至458×10^9／L和411×10^9／L。长期随访有效率：LS组为80％，OS组为75％。结论①LS治疗ITP的疗效与OS相近，二者均可作为ITP的有效治疗措施，治疗效果与手术方式无关；②IS较OS创伤小，术后恢复快，并发症少，住院时间短，伤口小而美观。③LS治疗儿童ITP安全有效，可替代OS成为治疗儿童ITP的措施。

[ Abstract] Objetive To explore laparoscopic splenectomy （LS） and open splenectomy （OS） in children patients with idiopathic thrombocytopenic purpura （ITP）. Methods A retrospective review of 30 children patients（ LS12,OS 18）who underwerit spleneetomy at the affiliated children Hospital Suzhou university during January 2003 to February 2012. Patients were followed up for 3 - 36 months after operation. Results 30 cases of children with ITP were underwent splenectomy successfully. ITP treatment efficiency was 91.67% （11/12） in LS and 94.44% （ 17/18 ） in OS. One week later the average amount of blood platelet increased to 458 × 109/L in LS and 411 ×109/L in OS. Long-term follow-up found that children with ITP treatment efficiency： the LS group was 80% ,the OS group was 75%. Mean operative time was 140 min for LS and 118 min for OS. The average amount of bleeding during operation was 43.2 mL for LS and 26.7 mL for OS. The average days of postoperative discharging were 8.5 day for LS and 11.5 day for OS. Conclusions （1） LS, where as of less traumatic and low morbidity, results in comparable effects as OS for the treatment of ITP. ITP treatment efficiency has no relation with the operation method. （2）Compared with OS, Laparoscopic splenectomy has advantages of micro-invasion, safety and quick recovery in the treatment of ITP, and is worthy of generalization and application. （3）Laparoscopic splenectomy is a good method of splenectomy with high safety and efficiency. LS may take the place of OS as a measure of the treatment of children with ITP.