腹腔镜脾切除治疗特发性血小板减少性紫癜九例体会

Laparoscopic splenectomy in treating idiopathic thrombocytopenic purpura

目的：探讨腹腔镜脾切除在特发性血小板减少性紫癜中的应用。方法回顾性分析2008年1月至2010年6月传统手术组13例，2010年6月至2012年1月腹腔镜脾切除组9例的临床资料。采用SPSSl3．0统计软件进行数据分析，组间比较用χ2检验，P ＜0．05被认为有统计学意义。结果腔镜组切除脾脏时间平均80 min，传统手术组平均75 min，两组差异无统计学意义（χ2＝0．79， P＞0．05）。腹腔镜组术中出血量平均130 ml（50～280 ml），传统手术组平均210 ml （60～450 ml），腹腔镜组术中出血量明显少于传统手术组（χ2＝25．79，P＜0．05）；术后腹腔镜组24～48 h内恢复胃肠蠕动，传统手术组48～96 h ，平均72 h（χ2＝194．03，P＜0．01）；平均住院时间腹腔镜组6．5 d明显少于传统手术组12．8 d，（χ2＝87．88，P＜0．01），以上数项差异均有统计学意义。术后随访6～48个月，腹腔镜组患者临床治愈率77．8％，传统手术组患者临床治愈率76．9％（χ2＝0．02，P＞0．05），差异无统计学意义。结论腹腔镜脾切除治疗特发性血小板减少性紫癜安全可行，具有创伤小、恢复快等优点。

Objective To investigate the clinical application of laparoscopic splenectomy in treating idiopatic thrombocytopenic purpura （ ITP） . Methods A retrospective analysis was performed in 9 patients with ITP, who had undergonelaparoscopic splenectomy from June 2010 to January 2012, and in 13 patients with ITP who had received traditional surgery from January 2008 to June 2010 in our hospital .Clinical data were analyzed by the chi-square test, using SPSS 13.0 software.A P value 〈0.05 was considered statistically significant. Results The average duration of laparoscopic splenectomy was 80 minutes but the duration in the traditional surgery group was 75 minutes （χ2 =0.79, P〉0.05）.The average blood loss in the laparoscopic group was 130 ml （50-280 ml）, which was significantly less than 210 ml in the traditional surgery group （60-450 ml） （χ2 =25.79, P〈0.05）.The time for postoperative recovery of gastrointestinal peristalsis in the laparoscopic group was 24 -48 hours, and in the traditional surgery group it was 48 -96 hours （average 72 hours）（χ2 =194.03, P〈0.01）.The average hospital stay in the laparoscopic group was 6.5 days, which was significantly less than 12.8 days in the traditional surgery group （χ2 =87.88, P〈0.01）.Follow-up for 6 -48 months showed a clinical cure rate of 77.8% in the laparoscopic group and 76.9%in the traditional surgery group （χ2 =0.02, P〉0.05）. Conclusion Laparoscopic splenectomy in treating IPT is safe and effective .It is charaterized by mini-invasiveness and quick recovery .