Herrera M F, Lozano-Salazar R R, Bezaury P, Césarman G, Hernández G, Sánchez S A, Velázquez A, López-Karpovitch X
Departamento de Cirugía, Instituto Nacional de la Nutrición Salvador Zubirán, México D.F.
Rev Invest Clin. 1998 Mar-Apr;50(2):127-32.
To describe the perioperative characteristics, complications and outcome of the first 22 patients who underwent laparoscopic splenectomy for refractary/recurrent ITP in our institution.
Clinical and biochemical characteristics, spleen size, indication for surgery, operative time, blood requirements, complications and outcome of 22 patients who underwent laparoscopic splenectomy between 1994 and 1997 were prospectively recorded. Their mean age was 40 +/- 15 (+/- SD), 15 females and 7 males.
The preoperative platelet count was 56 thousand +/- 58.7/uL, average spleen size 10.5 +/- 2 cm. The surgical time averaged 4.5 +/- 1 hours; accessory spleens were removed from two patients. Conversion to the open procedure was necessary in two cases. Complete response was achieved in 59%, partial response in 27%, and no response in 14% (none of these due to missed accessory spleens). Six patients developed complications. One of them died two days after surgery. The mean postoperative stay was 4.7 +/- 2.6 days.
The results of laparoscopic splenectomy were similar to our previous results with the open approach. The laparoscopic technique took longer in our hands but the postoperative stay was shorter.
描述我院首批22例因难治性/复发性免疫性血小板减少性紫癜（ITP）接受腹腔镜脾切除术患者的围手术期特征、并发症及预后情况。
前瞻性记录了1994年至1997年间接受腹腔镜脾切除术的22例患者的临床和生化特征、脾脏大小、手术指征、手术时间、血液需求量、并发症及预后情况。他们的平均年龄为40±15（±标准差）岁，女性15例，男性7例。
术前血小板计数为5.6万±58.7/μL，平均脾脏大小为10.5±2cm。手术时间平均为4.5±1小时；2例患者切除了副脾。2例患者需要转为开腹手术。完全缓解率为59%，部分缓解率为27%，无缓解率为14%（均非因遗漏副脾所致）。6例患者出现并发症。其中1例术后两天死亡。术后平均住院时间为4.7±2.6天。
腹腔镜脾切除术的结果与我们之前开腹手术的结果相似。在我们手中，腹腔镜技术耗时更长，但术后住院时间更短。
