Cordera Fernando, Long Kirsten Hall, Nagorney David M, McMurtry Erin K, Schleck Cathy, Ilstrup Duane, Donohue John H
Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Surgery. 2003 Jul;134(1):45-52. doi: 10.1067/msy.2003.204.
Since 1991, laparoscopic splenectomy (LS) has gained acceptance in the treatment of hematologic disorders, including idiopathic thrombocytopenic purpura (ITP). Several studies suggest that LS provides benefits over open splenectomy (OS). However, study design flaws hinder formal technology assessment.
We retrospectively reviewed medical and administrative records of patients who underwent splenectomy for ITP between January 1995 and December 2000 to compare clinical and economic outcomes associated with LS and OS.
Eighty-six patients were identified; 42 underwent an attempted LS and 44 had OS. Preoperative patient characteristics were similar between groups. Mean operative and anesthesia times for LS and OS were 167 and 201 minutes and 119 and 151 minutes, respectively (P <.001). Overall transfusion and postoperative complication rates were similar between groups. On average, LS patients required 1.2 fewer days of parenteral analgesia and were able to tolerate a general diet 1.7 days earlier. Mean postoperative stay was 2 days lower for LS patients and mean total direct costs did not differ by surgical method (US dollars 8134 vs US dollars 8200).
This observational study shows that LS is safe and offers advantages over OS: less postoperative pain, earlier general diet tolerance, and shorter hospital stay. These benefits are obtained at no significant additional cost.
自1991年以来，腹腔镜脾切除术（LS）在治疗包括特发性血小板减少性紫癜（ITP）在内的血液系统疾病方面已得到认可。多项研究表明，LS比开放性脾切除术（OS）更具优势。然而，研究设计缺陷阻碍了对该技术的正式评估。
我们回顾性分析了1995年1月至2000年12月期间因ITP接受脾切除术患者的医疗和行政记录，以比较LS和OS相关的临床和经济结果。
共纳入86例患者；42例尝试进行LS，44例接受OS。两组患者术前特征相似。LS和OS的平均手术时间和麻醉时间分别为167分钟和201分钟，119分钟和151分钟（P<.001）。两组的总体输血率和术后并发症发生率相似。平均而言，LS患者所需的胃肠外镇痛天数少1.2天，能够提前1.7天耐受普通饮食。LS患者的平均术后住院天数少2天，平均总直接成本在两种手术方式之间无差异（8134美元对8200美元）。
这项观察性研究表明，LS是安全的，并且相对于OS具有优势：术后疼痛更少、更早耐受普通饮食、住院时间更短。这些益处无需显著增加成本即可获得。
