对特发性血小板减少性紫癜行开放性和腹腔镜脾切除术的18年回顾。
An 18-year review of open and laparoscopic splenectomy for idiopathic thrombocytopenic purpura.
作者信息
Sampath Sharadh, Meneghetti Adam T, MacFarlane John K, Nguyen Nam H, Benny W Barrett, Panton Ormond N M
机构信息
Centre of Excellence for Surgical Education and Innovation, 3602-910 W. 10th Avenue, Vancouver, British Columbia, Canada V5Z 4E2.
出版信息
Am J Surg. 2007 May;193(5):580-3; discussion 583-4. doi: 10.1016/j.amjsurg.2007.02.002.
BACKGROUND
Laparoscopic splenectomy has become the preferred surgical procedure for the management of idiopathic thrombocytopenic purpura (ITP). However, there studies have directly compared the incidence of recurrent ITP secondary to missed accessory spleens in open versus laparoscopic splenectomy.
METHODS
Open and laparoscopic splenectomies performed for ITP at 4 sites over 18 years were analyzed. The incidence of recurrent disease secondary to missed accessory spleens was compared between the open and laparoscopic splenectomy groups.
RESULTS
A total of 105 splenectomies (54 open/51 laparoscopic) were performed. Accessory spleens were identified in 6 laparoscopic and 6 open cases (P = .57). Recurrent disease occurred in 27.6% of open and 14.6% of laparoscopic cases (P = .222). There were no cases of recurrent ITP secondary to a missed accessory spleen in either group.
CONCLUSIONS
The incidence of missed accessory spleens causing recurrent disease is similar when splenectomy is performed either open or laparoscopically.
背景
腹腔镜脾切除术已成为治疗特发性血小板减少性紫癜（ITP）的首选手术方法。然而，尚无研究直接比较开腹脾切除术与腹腔镜脾切除术时因遗漏副脾导致ITP复发的发生率。
方法
分析了18年间在4个地点为ITP患者实施的开腹和腹腔镜脾切除术。比较开腹脾切除术组与腹腔镜脾切除术组因遗漏副脾导致疾病复发的发生率。
结果
共进行了105例脾切除术（54例开腹/51例腹腔镜）。在6例腹腔镜手术和6例开腹手术中发现了副脾（P = 0.57）。开腹手术病例中27.6%出现疾病复发，腹腔镜手术病例中14.6%出现疾病复发（P = 0.222）。两组均无因遗漏副脾导致ITP复发的病例。
结论
开腹或腹腔镜行脾切除术时，因遗漏副脾导致疾病复发的发生率相似。
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