腹腔镜脾切除治疗极重度免疫性血小板减少性紫癜的临床研究

Clinical evaluation of laparoscopic splenectomy for extremely severe idiopathic thrombocytopenic purpura

目的：探讨腹腔镜脾切除术治疗极重度免疫性血小板减少性紫癜的临床效果。方法：选取2010年1月至2015年7月行腹腔镜脾脏切除术的258例免疫性血小板减少性紫癜患者,128例血小板低于10×10 9/L,130例血小板高于10×10 9/L,对比分析两组患者行腹腔镜脾切除术的疗效。结果：258例手术均获成功,两组患者术前临床资料差异无统计学意义,术中出血量、手术时间、术后住院时间、术后腹腔引流时间、术后并发症总发生率、术后总有效率差异亦无统计学意义。结论：腹腔镜脾脏切除术治疗血小板低于10×10 9/L的极重度免疫性血小板减少性紫癜患者是安全、可行的,术前、术中不输注血小板并不增加手术风险,术后并发症并未增加,术后总有效率亦不受影响。

Objective： To investigate the clinical effect of laparoscopic splenectomy for extremely severe idiopathic thrombocytopenic purpura（ ITP）. Methods： From Jan. 2010 to Jul. 2015,258 cases of ITP were collected in West China Hospital,divided in two groups and treated by laparoscopic splenectomy. There were 128 cases of ITP with platelet less than 10 × 10 9/ L and 130 cases of ITP with platelet higher than 10 × 10 9/ L. The curative effect of laparoscopic splenectomy between the two groups were comparatively analyzed. Results： All 258 patients were operated successfully. There was no significant difference in preoperative clinical data between the two groups of patients. There were no significant differences in intraoperative blood loss,operation time,postoperative hospital stay,postoperative abdominal drainage time,postoperative complications and postoperative total effective rate between the two groups of patients.Conclusions： Laparoscopic splenectomy for the treatment of patients with severe ITP,whose platelet is less than 10 × 10 9/ L,is safe and feasible. No platelet infusion before operation and during operation neither increases operative risk or postoperative complications,nor affects postoperative total effective rate.