Friedman R L, Fallas M J, Carroll B J, Hiatt J R, Phillips E H
Department of Surgery, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Surg Endosc. 1996 Oct;10(10):991-5. doi: 10.1007/s004649900221.
A comparison of safety, efficacy, and cost of laparoscopic splenectomy (LS) vs open splenectomy (OS) for idiopathic thrombocytopenic purpura (ITP) was performed.
The records of 49 consecutive patients who underwent splenectomy for ITP (31 LS and 18 OS) at a large metropolitan teaching hospital between 3/91 and 8/95 were reviewed. Morbidity, mortality, hospital stay, operative time, blood loss, time to oral fluid intake, direct costs, and operating room (OR) costs were analyzed.
Age, sex, comorbidity, and spleen size were similar in both groups. LS was successful in 94% of patients in whom it was attempted. Operative times showed a learning curve for LS, with average times for the last ten cases (94 +/- 35 min) significantly shorter than for the first ten (p = 0.01) and also shorter than for OS (103 +/- 45 min). Postsurgical hospital stay was 2.9 +/- 1.3 days for LS and 6.9 +/- 3. 0 days for OS (p < 0.001). Patients tolerated an oral diet 1.2 +/- 0. 5 days after LS and 3.2 + 0.7 days after OS (p < 0.001). Direct hospital cost was $5,509 +/- 3,636 for LS and $9,031 +/- 12,752 for OS. In the LS group, six patients (21%) had accessory spleens identified and removed, compared with two patients (11%) in the OS group. Platelet counts did not respond in two (7%) patients in the LS group, but no accessory spleens were identified by nuclear scan. One major complication occurred in the LS group. There were no cases of splenosis or mortality in either group.
LS is a safe and effective treatment for ITP, with significantly shorter postoperative hospital stay than OS.
对腹腔镜脾切除术（LS）与开放性脾切除术（OS）治疗特发性血小板减少性紫癜（ITP）的安全性、有效性及成本进行比较。
回顾了1991年3月至1995年8月间在一家大型都市教学医院连续接受脾切除术治疗ITP的49例患者的记录（31例行LS，18例行OS）。分析了发病率、死亡率、住院时间、手术时间、失血量、开始经口进食时间、直接成本及手术室成本。
两组患者的年龄、性别、合并症及脾脏大小相似。LS在94%尝试该手术的患者中成功实施。手术时间显示LS存在学习曲线，最后10例的平均手术时间（94±35分钟）显著短于前10例（p = 0.01），且也短于OS组（103±45分钟）。LS术后住院时间为2.9±1.3天，OS为6.9±3.0天（p < 0.001）。LS术后患者1.2±0.5天可耐受经口饮食，OS术后为3.2±0.7天（p < 0.001）。LS的直接住院成本为5509±3636美元，OS为9031±12752美元。LS组有6例（21%）患者发现并切除了副脾，OS组为2例（11%）。LS组有2例（7%）患者血小板计数无反应，但核素扫描未发现副脾。LS组发生1例严重并发症。两组均无脾种植或死亡病例。
LS是治疗ITP的一种安全有效的方法，术后住院时间明显短于OS。
