Gigot J F, Healy M L, Ferrant A, Michaux J L, Njinou B, Kestens P J
Department of Digestive Surgery, St Luc University Hospital, Louvain Medical School, Brussels, Belgium.
Br J Surg. 1994 Aug;81(8):1171-2. doi: 10.1002/bjs.1800810830.
Laparoscopic splenectomy was performed on eight patients with idiopathic thrombocytopenic purpura refractory to medical treatment. Preoperative infusion of immunoglobulin G gamma-globulin was used to boost the platelet count. Accessory spleens were sought by preoperative computed tomography and peroperative examination of the usual anatomical locations. Seven patients underwent successful laparoscopic splenectomy, with a mean postoperative stay of 3.6 days. One patient with an accessory spleen detected before operation but not during laparoscopy required conversion to open surgery for control of haemorrhage from the splenic hilum. Another patient had a transient pancreatic fistula. Laparoscopic splenectomy is feasible and sfe in patients with idiopathic thrombocytopenic purpura. Long-term results require evaluation as detection of accessory spleens can prove difficult during laparoscopy.
对8例药物治疗无效的特发性血小板减少性紫癜患者实施了腹腔镜脾切除术。术前输注免疫球蛋白Gγ-球蛋白以提高血小板计数。术前通过计算机断层扫描和术中对常见解剖位置的检查来寻找副脾。7例患者成功接受了腹腔镜脾切除术，术后平均住院时间为3.6天。1例术前发现有副脾但腹腔镜检查时未发现的患者，因脾门出血需要转为开放手术以控制出血。另1例患者出现了短暂性胰瘘。腹腔镜脾切除术对特发性血小板减少性紫癜患者是可行且安全的。由于在腹腔镜检查期间可能难以发现副脾，因此需要评估长期结果。
