特发性血小板减少性紫癜脾切除术后复发：腹腔镜脾切除术在副脾治疗中的作用
Postsplenectomy recurrence of idiopathic thrombocitopenic purpura: role of laparoscopic splenectomy in the treatment of accessory spleen.
作者信息
Leo C A, Pravisani R, Bidinost S, Baccarani U, Bresadola V, Risaliti A, Terrosu G
出版信息
G Chir. 2015 Jul-Aug;36(4):153-7. doi: 10.11138/gchir/2015.36.4.153.
AIM
Idiopatic thrombocytopenic purpura (ITP) is the most common indication for splenectomy. The failure rate of surgery is about 8% and the failure rate after splenectomy is approximately 28% for all patients. When the presence of an accessory spleen is diagnosed, splenectomy is recommended. Laparoscopic approach is considered the first choice.
PATIENTS AND METHODS
At our Department, between July and November 2011 two patients underwent laparoscopic accessory splenectomy for recurrence of ITP. Both patients had a previously laparoscopic splenectomy. Preoperative Magnetic Resonance (MR) was performed in both the cases revealing the presence of an accessory spleen.
RESULTS
The operative time was 105 and 100 minutes respectively. No perioperative complications occured. Hospital stay was four days in both cases. The first patient had a disease free period of two months; the second one of one month. Both patients restarted immunosuppressive therapy.
CONCLUSIONS
The relapse of thrombocytopenia post-splenectomy can be associated with the presence of an accessory spleen. The laparoscopic accessory splenectomy should be considered the first choice approach. Surgical accessory splenectomy allows a transitory remission of the disease.
目的
特发性血小板减少性紫癜（ITP）是脾切除术最常见的适应证。手术失败率约为8%，所有患者脾切除术后的失败率约为28%。当诊断出存在副脾时，建议进行脾切除术。腹腔镜手术被认为是首选方法。
患者与方法
在我们科室，2011年7月至11月期间，两名因ITP复发的患者接受了腹腔镜副脾切除术。两名患者此前均接受过腹腔镜脾切除术。两例患者术前均进行了磁共振成像（MR）检查，结果显示存在副脾。
结果
手术时间分别为105分钟和100分钟。未发生围手术期并发症。两例患者的住院时间均为4天。第一例患者有两个月的无病期；第二例有一个月的无病期。两名患者均重新开始免疫抑制治疗。
结论
脾切除术后血小板减少症的复发可能与副脾的存在有关。腹腔镜副脾切除术应被视为首选方法。手术切除副脾可使疾病得到暂时缓解。
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