Aramaki Masanori, Matsumoto Toshifumi, Kitano Seigo
Department of Surgery I, Oita Medical University.
Nihon Rinsho. 2003 Apr;61(4):599-603.
Idiopathic thrombocytopenic purpura(ITP) is an immune disorder, which causes an acute or chronic thrombocytopenia, and may result in potentially life-threatening hemorrhage. Splenectomy is one of the treatment options that needs to be weighted in the treatment of ITP, particularly in cases that have shown response failure to medical modalities such as prednisone, or anti-D globulin therapy. However, because open splenectomy (OS) requires more surgical invasiveness, surgical treatment had not been accepted for many patients with ITP. Recently, laparoscopic splenectomy(LS) is being accepted as an effective alternative to OS in treating ITP. The most important parts of this method are, mobilization of the spleen by dissection of the splenic ligament, and the blocking of blood circulation to the spleen by division of the hilar arteries and veins. The procedure is as follows: (1) The patient is in a right lateral decubitus position. (2) The resection of the splenic ligament is made by an ultrasonic coagulating dissector. (3) The splenic hilum is dissected with an auto-stapler. (4) The freed spleen is contained in a nylon bag and extracted. Laparoscopic splenectomy is a feasible and safe for patients with ITP.
特发性血小板减少性紫癜（ITP）是一种免疫性疾病，可导致急性或慢性血小板减少，并可能引发危及生命的出血。脾切除术是ITP治疗中需要权衡的治疗选择之一，尤其是对于那些对泼尼松或抗-D球蛋白治疗等药物治疗无反应的病例。然而，由于开放性脾切除术（OS）需要更大的手术创伤，许多ITP患者并不接受手术治疗。近年来，腹腔镜脾切除术（LS）被认为是治疗ITP的一种有效替代OS的方法。该方法最重要的步骤是通过解剖脾韧带游离脾脏，并通过切断脾门动静脉来阻断脾脏的血液循环。手术步骤如下：（1）患者取右侧卧位。（2）用超声凝固分离器切除脾韧带。（3）用自动吻合器解剖脾门。（4）将游离的脾脏装入尼龙袋中取出。腹腔镜脾切除术对ITP患者是可行且安全的。
