腹腔镜脾切除术治疗血小板计数偏低免疫性血小板减少性紫癜

Laparoscopic Splenectomy Applied in the Treatment of low Platelet Count Idiopathic Thrombocytopenic Purpura

目的探讨腹腔镜脾切除术治疗血小板计数偏低免疫性血小板减少性紫癜(ITP)。方法选取我院2014年9月至2016年2月期间收治的经确诊的内科治疗无效或不耐受的ITP患者84例,随机将患者分为观察组45例和对照组39例;观察组行腹腔镜脾切除术,对照组行开放性脾切除术。观察和统计两组手术基本情况,比较两组临床手术疗效,并观察两组术后并发症发生情况。结果与对照组相比,观察组手术时间(92.47±21.18)min、住院时间(8.32±2.29)d显著较短(P<0.01),术中出血量(43.95±19.74)ml、后48 h总引流量(65.64±45.22)ml明显较少(P<0.01)。观察组手术疗效总有效率为93.33%显著高于对照组76.92%(P<0.05)。观察组术后并发症发生率11.11%明显低于对照组28.21%(P<0.05)。结论与开放性脾切除术相比,腹腔镜脾切除术治疗ITP手术时间短,术中出血量、术后引流量少,手术疗效好,并发症发生率更低,安全性可行性高。

Objective To investigate the feasibility of laparoscopic splenectomy applied in the treatment of low platelet count idiopathic thrombocytopenic purpura （ ITP）. Methods 84 patients with ITP receiving invalid medical treatment and or being intolerant who were diagnosed in our hospital between September 2014 and February 2016 were randomized into observation group（45 cases）and control group（39 cases）. The observation group underwent laparoscopic splenectomy while control group underwent open splenectomy. The basic situation in both groups was observed. The clinical curative effect was compared between the two groups and the incidence of postoperative complications in both groups was observed. Results The operation time[ （ 92.47 ± 21.18 ） min] and length of hospital stay [ （ 8.32 ± 2.29 ） d ] of observation group was significantly shorter than control group（P 〈 0.01 ）. The intraoperative blood loss[ （43.95 ± 19.74） ml]and postoperative 48 h total drainage volume[ （65.64 ± 45.22）ml] was significantly less than control group （P 〈 0. 01 ）. The total response rate in the observation group （93.33 % ）was significantly higher than the control group （ P 〈 0. 05 ）. The incidence rate of postoperative complications in the observation group （11.11%） was significantly lower than that in the control group （28.21%）（ P 〈 0. 05 ）. Conclusion Compared with open splenectomy,the time of laparoscopic splenectomy in the treatment of ITP is shorter,and intraoperative blood loss and postoperative drainage volume is less, with good curative effect, lower incidence of complications and high safety and feasibility.