特发性血小板减少性紫癜行腹腔镜脾切除术的技术要点和体会

To explore experience and surgical technique of laparoscopic splenectomy in the treatment of refractory idiopathic thrombocytopenic purpura

目的探索免疫性血小板减少症(ITP)患者行腹腔镜脾切除术(LS)的手术要点和体会。方法对2010年3月至2015年3月我科收治的难治性免疫性血小板减少症患者71例临床资料进行分析。结果 65例顺利完成LS术;6例因术野出血中转开腹;2例出现胰漏,保守治疗治愈。出血是中转开腹的主要原因,胰漏与损伤胰尾有关。结论因为大剂量服用糖皮质激素,难治性ITP患者腹腔网膜增厚增多质脆术野暴露困难,血小板低有凝血障碍,也增加了手术难度。精心的术前准备,正确的手术操作,是顺利完成LS的保证。

Objective To explore surgical skills and experience of laparoscopic splenectomy（LS） in the treatment of refractory idiopathic thrombocytopenic purpura（ITP） . Methods The clinical data of 71 patients with ITP who underwent LS between Mar 2010 and Mar 2015 were retrospectively analyzed. Results Except 6（8.5% ）cases were converted to open surgery because of bleeding,65 （91.5%） patients successfully underwent LS. pancreatic leakage occurred in 2 cases and, cured with conservative treatment. hemorrhage is the main reason for transfer open operation pancreatic fistula was associated with cauda pancreatis injury. Conclusions Due to high dose glucocorticoid, Abdominal omental of Refractory ITP become hypertrophy and crisp, Which make it difficult to expose operation field, low platelets lead to coagulation disorders, also increased the difficulty of the operation. But with the careful preoperative preparation , reasonable surgical skills, LS can be Completed successfully.