Yuan R H, Chen S B, Lee W J, Yu S C
Department of Surgery, National Taiwan University Hospital, Taipei. Taiwan.
J Formos Med Assoc. 1998 Jul;97(7):485-9.
Recent advancements in laparoscopic surgery have made laparoscopic splenectomy possible. We retrospectively compared the outcomes of laparoscopic versus open splenectomy in patients with idiopathic thrombocytopenic purpura (ITP) or beta-thalassemia. From July 1993 to July 1997, 52 patients (ITP, 43 cases; beta-thalassemia, 9 cases) underwent either laparoscopic (30 patients, 9 men, 21 women; average age, 36.9 years) or conventional open splenectomy (22 patients, 5 men, 17 women; average age, 34.3 years). The two groups were similar in terms of sex, age, diagnosis, duration of disease, preoperative platelet count, and spleen size. The mean surgical time, estimated amount of blood loss, duration of postoperative recovery, analgesic usage, and complications were compared between the two groups. Laparoscopic splenectomy was successful in 29 (97%) of the 30 patients. The mean surgical time in the laparoscopy group was longer than in the open splenectomy group (190.6 vs 113.9 minutes, p < 0.01). The laparoscopy group had earlier postoperative oral intake (15.2 vs 52.6 hours, p < 0.01), less usage of analgesics (meperidine 50 mg/unit, 1.1 vs 2.8 units, p < 0.01) and a shorter postoperative hospital stay (4.1 vs 6.8 days, p < 0.01). The estimated blood loss, incidence of accessory spleen, surgical complication rate, and recurrence rate of thrombocytopenia were similar in the two groups. Our findings show that laparoscopic splenectomy in patients with ITP or beta-thalassemia is as safe as the open approach. While laparoscopy required a longer surgical time, the recovery period was shorter, analgesic use was less, and physical discomfort was less severe.
腹腔镜手术的最新进展使得腹腔镜脾切除术成为可能。我们回顾性比较了特发性血小板减少性紫癜（ITP）或β地中海贫血患者行腹腔镜脾切除术与开放性脾切除术的结果。1993年7月至1997年7月，52例患者（ITP 43例；β地中海贫血9例）接受了腹腔镜手术（30例患者，9例男性，21例女性；平均年龄36.9岁）或传统开放性脾切除术（22例患者，5例男性，17例女性；平均年龄34.3岁）。两组在性别、年龄、诊断、病程、术前血小板计数和脾脏大小方面相似。比较了两组的平均手术时间、估计失血量、术后恢复时间、镇痛药物使用情况及并发症。30例患者中有29例（97%）腹腔镜脾切除术成功。腹腔镜组的平均手术时间比开放性脾切除术组长（190.6分钟对113.9分钟，p<0.01）。腹腔镜组术后更早恢复经口进食（15.2小时对52.6小时，p<0.01），镇痛药物使用更少（哌替啶50mg/单位，1.1单位对2.8单位，p<0.01），术后住院时间更短（4.1天对6.8天，p<0.01）。两组的估计失血量、副脾发生率、手术并发症发生率和血小板减少症复发率相似。我们的研究结果表明，ITP或β地中海贫血患者行腹腔镜脾切除术与开放性手术一样安全。虽然腹腔镜手术需要更长的手术时间，但恢复期更短，镇痛药物使用更少，身体不适也更轻。
