Zychowicz Anna, Radkowiak Dorota, Lasek Anna, Małczak Piotr, Witowski Jan, Major Piotr, Strzałka Marcin, Kulawik Jan, Budzyński Andrzej, Pędziwiatr Michał
2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
Centre for Research, Training and Innovation in Surgery, Krakow, Poland.
Wideochir Inne Tech Maloinwazyjne. 2018 Jun;13(2):157-163. doi: 10.5114/wiitm.2018.75847. Epub 2018 May 16.
Laparoscopic splenectomy (LS) is the gold standard in treating immune thrombocytopenia (ITP). However, there are still some problems in decision-making when considering LS in patients with a very low platelet count (PLT).
To evaluate safety outcomes of LS in patients with severe ITP and very low PLT in comparison to those with higher PLT.
We retrospectively analyzed consecutive patients who underwent LS in a single institution between April 1998 and December 2017. Perioperative care was based on an algorithm developed at our department which takes into consideration the patient's PLT level. Patients were divided into 2 groups depending on the PLT level (cut-off point 50,000/mm).
The mean operative time in the low PLT group and high PLT group was 90 ±42.1 min and 95 ±45 min, respectively (p = 0.59). Intraoperative blood loss was 144 ±226.1 ml in the low PLT group and 83 ±161.24 ml in the high PLT group (p = 0.23). Complications occurred in 5 (9.09%) patients in the low PLT group and 16 (11.51%) in the high PLT group (p = 0.67). There were no conversions in the group with lower PLT, while 2 patients in the group with higher PLT had to be converted to open surgery (p = 0.38). Patients with low PLT preoperatively more often required perioperative platelet transfusions (13 vs. 1, p < 0.001).
Laparoscopic splenectomy is safe and feasible treatment in patients with ITP regardless of the PLT level. Still, patients with critical ITP and marginally low PLT require special awareness.
腹腔镜脾切除术（LS）是治疗免疫性血小板减少症（ITP）的金标准。然而，对于血小板计数（PLT）极低的患者，在考虑行LS时，决策过程中仍存在一些问题。
比较重度ITP且PLT极低的患者与PLT较高的患者行LS后的安全结局。
我们回顾性分析了1998年4月至2017年12月在单一机构接受LS的连续患者。围手术期护理基于我们科室制定的算法，该算法考虑了患者的PLT水平。根据PLT水平（临界点为50,000/mm³）将患者分为两组。
低PLT组和高PLT组的平均手术时间分别为90±42.1分钟和95±45分钟（p = 0.59）。低PLT组术中失血量为144±226.1毫升，高PLT组为83±161.24毫升（p = 0.23）。低PLT组有5例（9.09%）患者发生并发症，高PLT组有16例（11.51%）（p = 0.67）。低PLT组无一例中转开腹，而高PLT组有2例患者不得不转为开腹手术（p = 0.38）。术前PLT低的患者围手术期更常需要输注血小板（13例对1例，p < 0.001）。
无论PLT水平如何，腹腔镜脾切除术对ITP患者都是安全可行的治疗方法。尽管如此，对于重症ITP且PLT略低的患者仍需特别关注。
