血小板减少患者行腹腔镜脾切除的可行性及疗效

Efficacy and feasibility of laparoscopic splenectomy in patients with a low platelet count

目的 探讨腹腔镜脾切除术治疗血小板（PLT）数量较低的免疫性血小板减少性紫癜（ITP）的可行性及疗效.方法 回顾性分析2010-2014年收治的76例行腹腔镜脾切除术的ITP患者临床资料.将PLT＜ 30×109/L定义为数量较低.根据术前PLT数量将患者分为A（n=14;＜10×109/L）、B（n =34;10 ～30×109/L）、C（n =28;＞30×109/L）三组.比较三组患者腹腔镜脾切除术后指标及血液学疗效.结果 76例腹腔镜脾切除术均获得成功.A组患者平均手术时间（198.9±46.2）m in,较B组（135.6±24.1）min、C组（125.4±30.0）min差异有统计学意义（P＜0.05）;术中出血量A组（182.9±37.3） ml,较B组（104.1±21.4） ml、C组（102.1 ±43.6） ml差异有统计学意义（P＜0.05）.三组患者在术后并发症及术后住院时间方面差异无统计学意义（P＞0.05）.所有患者术后2、6、12个月随访行血液学疗效判定,A组患者术后有效率约（42.9％）,与C组（75％）相比差异有统计学意义（P＜0.05）,与B组（64.7％）相比差异无统计学意义（P＞0.05）.结论 术前PLT数量较低对腹腔镜脾切除患者术后恢复及疗效有一定影响,但该手术同样安全可行.

Objective To investigate the feasibility and efficacy of laparoscopic splenectomy （LS） in patients with a low platelet count.Methods To retrospectively analyse the database of 76 ITP patients operated from 2010 to 2014.A low platelet count was defined as a platelet count of less than-30 × 109/L.The patients were divided into three groups：A （0～ 10 × 109/L）,B （10～30 × 109/L）,C （〉30 × 109/L） based on preoperative platelet counts.The surgical outcomes and hematological outcomes were compared among the three groups after LS.Results The operations on the 76 patients were all successfully carried out.The mean operating time of group A was （198.9 ±46.2） min,and it was significantly longer when compared with group B （135.6 ±24.1） min and group C （125.4 ±30.0） min （P 〈0.05）.The mean intraoperative blood loss of group A was （182.9 ±37.3） ml,which was significantly more when compared with group B （104.1 ±21.4） ml and group C （102.1 ±43.6） ml,（P 〈0.05）.There were no significant difference among the three groups in postoperative complication rate and length of postoperative hospital stay,（P 〉 0.05）.All patients were followed up at 2,6 and 12 months after the operation and the hematological outcomes were measured.The successful therapeutic rates after LS in group A was 42.9%,and it was significantly worse when compared with group C （75%） （P 〉0.05）;there was no significant difference when compared with group B （64.7%）,（P 〈 0.05）.Conclusion Low preoperative platelet counts have an impact on the efficacy and postoperative recovery after laparoscopic splenectomy.LS was safe and feasible for [TP patients with low preoperative platelet counts.