[1]郑朝旭,吴志棉,陈国泰,等.腹腔镜脾切除术治疗难治性特发性血小板减少性紫癜[J].中国微创外科杂志,2005,05(1):52-53.
　Zheng Chaoxu,Wu Zhimian,Chen Guotai,et al.Laparoscopic splenectomy for refractory idiopathic thrombocytopenic purpura[J].Chinese Journal of Minimally Invasive Surgery,2005,05(1):52-53.
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腹腔镜脾切除术治疗难治性特发性血小板减少性紫癜()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
05
期数:
2005年1期
页码:
52-53
栏目:
出版日期:
2005-01-30

文章信息/Info

Title:
Laparoscopic splenectomy for refractory idiopathic thrombocytopenic purpura
作者:
郑朝旭; 吴志棉; 陈国泰; 谭敏; 李文姬; 余俊峰; 赵振;  陈流华
中山大学附属第一医院普通外科,广州,510080
Author(s):
Zheng Chaoxu;  Wu Zhimian;  Chen Guotai;  et al.
Department of General Surgery, First AffiliatedHospital of Sun Yat-sen University, Gangzhou 510080, China
关键词:
腹腔镜;  脾切除术;  特发性血小板减少性紫癜
Keywords:
Laparoscopy; 　Splenectomy; 　Idiopathic thrombocytopenic purpura
分类号:
R657.6
文献标志码:
A
摘要:
目的探讨腹腔镜脾切除术(laparoscopic splenectomy,LS)治疗内科药物治疗无效的难治性特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)的可行性和疗效. 方法回顾性分析1999年9月～2004年7月31例难治性ITP(血小板计数<50×109/L)行LS的临床资料.采用全麻、右侧斜卧位或完全右侧卧位、三孔法(27例)或四孔法(4例)进行手术. 结果 2例中转传统开腹手术.29例完成LS,手术时间为65 ～325 min,平均137 min.术中出血量50 ～600 ml,平均116 ml.6例术中发现副脾并切除.术后2例切口感染,1例切口皮下血肿.术后随访3～41个月,平均11个月,16例(55.2%)完全显效,8例(27.6%)部分显效,总有效率82.8%(24/29). 结论 LS治疗难治性ITP安全可行,效果良好.
Abstract:
Objective　To investigate the feasibility and effectiveness of laparoscopic splenectomy (LS) in patients with refractory idiopathic thrombocytopenic purpura (ITP) resistant to medical management.　Methods　Clinical data of 31 cases of refractory ITP (platelet count < 50×109/L) undergoing LS between September 1999 and July 2004 were analyzed retrospectively. The patients were placed in right lateral semidecubitus or decubitus position. All the operations were performed under general anesthesia by using either three-port technique (27 cases) or four-port technique (4 cases).　Results　Conversions to traditional open surgery were required in 2 cases. LS was successfully conducted in 29 cases, with an operative time of 65~325 min (mean, 137 min) and an estimated intraoperative blood loss of 50 ~600 ml (mean, 116 ml). Accessory spleen was found and removed during the surgery in 6 patients. Postoperatively, there were 2 cases of wound infection and 1 case of incisional subcutaneous hematoma. Follow-up for 3~41 months(mean,11 mohths) showed 16 cases of complete response (55.2%) and 8 cases of partial response (27.6%), the total response rate being 82.8% (24/29).　Conclusions　Use of LS for refractory ITP is safe, feasible and effective.

参考文献/References:

[1]George JN, Woolf SH, Raskob GE. Idiopathic thrombocytopenic purpura: a guideline for diagnosis and management of children and adults. American Society of Hematology. Ann Med, 1998, 30(1):38-44.
[2]Szold A, Sagi B, Merhav A, et al. Optimizing laparoscopic splenectomy: Technical details and experience in 59 patients. Surg Endosc, 1998,12(8):1078-1081.
[3]Wani NA, Parray FQ. Therapeutic splenectomy in immune thrombocytopenic purpura. World J Surg, 2000, 24(1):92-94.
[4]Kumar S, Diehn FE, Gertz MA, et al. Splenectomy for immune thrombocytopenic purpura: long-term results and treatment of postsplenectomy relapses. Ann Hematol, 2002, 81(6):312-319.
[5]Berends FJ, Schep N, Cuesta MA, et al. Hematological long-term results of laparoscopic splenectomy for patients with idiopathic thrombocytopenic purpura: a case control study. Surg Endosc, 2004,18(5):766-770.
[6]Totte E, Van Hee R, Kloeck I, et al. Laparoscopic splenectomy after arterial embolisation. Hepatogastroenterology, 1998,45(21):773-776.
[7]Cordera F, Long KH, Nagorney DM, et al. Open versus laparoscopic splenectomy for idiopathic thrombocytopenic purpura: clinical and economic analysis. Surgery, 2003,134(1):45-52.

备注/Memo

备注/Memo:
①手术室
更新日期/Last Update: 2014-03-11