腹腔镜脾切除术治疗难治性血小板减少性紫癜的临床应用  

Application of laparoscopic splenectomy in the treatment of idiopathic thrombocytopenic purpura

作　　者：侍阳[1] 宋庆伟[1] 于生才[1] 邹海明[1] 陈宝鹤 

机构地区：[1]徐州医学院附属医院,江苏徐州221002

出　　处：《腹腔镜外科杂志》2014年第5期356-358,共3页Journal of Laparoscopic Surgery

摘　　要：目的：探计腹腔镜脾切除术（laparoscopic splenectomy，LS）治疗特发性血小板减少性紫癜（idiopa thicthrombocytopenic purpura，ITP）的临床效果。方法：回顾分析为50例ITP患者行Ls的临床资料。结果：6例中转开腹，44例（88％）顺利完成完全腹腔镜脾切除术，手术时间平均（122．7±35．7）min，术中出血量平均（113．6±95．3）ml，8例术中发现副脾并切除。术后6—12h患者均可下床活动，24—48h胃肠蠕动恢复停胃肠减压，3—6d拔除脾窝引流管，术后平均住院（8．0±2．2）d。术后36例患者血小板很快上升，7—10d至峰值，有效率81．8％。本组无一例手术死亡，术后腹腔出血2例。腹壁穿刺孔皮下血肿2例。结论：LS具有患者创伤小、术中出血少、康复快、并发症发生率低等优点，术者具备一定的开腹手术经验及熟练的腹腔镜操作技术，遵循由易至难、由简到繁、循序渐进的原则，LS治疗ITP是安全、可行的，效果满意。Objective：To investigate the clinical efficacy of laparoseopic spleneetomy （LS） in the treatment of refractory idio- pathic thromboeytopenie purpura （ITP）. Methods：The clinical data of 50 patients with ITP who underwent LS were retrospectively analyzed. Results：Except 6 cases were converted to open surgery ,44 （88%） patients successfully underwent LS. The mean operative time was （122.7 -＋ 35.7 ） min,intraoperative mean blood loss was （113.6 ＋ 95.3） ml. During operation accessory spleens were found in 8 cases and excised. In all cases,out-of-bed activity committed within 6-12 h,gastrointestinal peristalsis recovered in 24 to 48 h after operations,and gastrointestinal decompression was stopped. Abdominal cavity drainage quitted within 3-6 d, and the mean postoperative hospital stay was （8.0 ± 2.2 ） d. The platelet count of 36 cases elevated rapidly after operations and the peak value appeared in 7-10 d. Total effective rate reached 81.8% accordingly. No death associated with operation was found. Postoperatiye complications occurred in 4 cases including 2 cases of abdominal cavity bleeding and 2 cases of abdominal wall eechymoma. Conclusions ： LS contains obvious supe- riorities such as minimal invasion, fast recovery, few blood loss and incidence of complications, so it is a feasible, safe and effective measure for treatment of ITP. Surgeons should own experience of laparotomy and laparoscopy, and abide by following principles：from easy to difficult, from simple to complicated and step by step.

关 键 词：紫癜 血小板减少性 特发性 脾切除术 腹腔镜检查 

分 类 号：R657.6[医药卫生—外科学]