Espert J J, Targarona E M, Cervantes F, Bombuy E, Rives S, Balagué C, Perales M, Nomdedeu B, Montserrat E, Trias M
Servicios de Cirugía General y Digestiva, Hospital Clínic i Provincial, Barcelona.
Med Clin (Barc). 1998 Oct 31;111(14):525-8.
Several studies have shown the potential advantages laparoscopic splenectomy (LS) over open surgery. The aim of this study has been to evaluate the advantages of LS over open surgery in the treatment of autoimmune thrombocytopenia.
54 consecutive patients splenectomized for the treatment of idiopathic thrombocytopenic purpura (ITP) or HIV-related thrombocytopenia were analyzed. Operative features (operative time, conversion to open surgery, accessory spleens), immediate (stay, analgesia and blood transfusion requirements) and late postoperative features (platelet count), as well as splenectomy-related complications in both surgical procedures were compared.
Between February 1990 and February 1997, 54 splenctomies were performed for the treatment of autoimmune thrombocytopenia (ITP, n = 47, and HIV-related thrombocytopenia, n = 7). Eighteen were performed through an open approach, and 36 by laparoscopy. Both groups were comparable with regard to age, sex, platelet count, disease duration and body mass index. LS was completed in 34 cases (conversion to open surgery: 5.5%). The incidence of accessory spleens was 11% in the LS group and 5.5% in the open surgery group. Postoperative morbidity (16% vs 28%) and blood requirements (25% vs 33%) were lower after LS, but the differences did not reach statistical significance. Analgesia requirements (7 [SD 3] vs 11 [6]; p < 0.01) and postoperative stay (3.8 [2.6] vs 7.4 [3] days; p < 0.01) were significantly shorter after LS. Following splenectomy, the platelet counts became normal in 72% of patients submitted to LS and 78% of patients in the open surgery group. After 20 and 63 months mean follow-up, one patient in each group developed late complications.
As compared to open surgery, LS offers a better immediate clinical outcome, with similar long-term results.
多项研究已表明腹腔镜脾切除术（LS）相较于开放手术具有潜在优势。本研究的目的是评估LS在治疗自身免疫性血小板减少症方面相对于开放手术的优势。
分析了54例因治疗特发性血小板减少性紫癜（ITP）或HIV相关血小板减少症而接受脾切除术的连续患者。比较了手术特征（手术时间、转为开放手术、副脾情况）、近期（住院时间、镇痛需求和输血需求）和术后远期特征（血小板计数），以及两种手术方式中与脾切除术相关的并发症。
1990年2月至1997年2月期间，共进行了54例用于治疗自身免疫性血小板减少症的脾切除术（ITP 47例，HIV相关血小板减少症7例）。18例采用开放手术方式，36例采用腹腔镜手术。两组在年龄、性别、血小板计数、疾病持续时间和体重指数方面具有可比性。34例完成了腹腔镜脾切除术（转为开放手术：5.5%）。腹腔镜组副脾发生率为11%，开放手术组为5.5%。腹腔镜脾切除术后的术后发病率（16%对28%）和输血需求（25%对33%）较低，但差异未达到统计学意义。腹腔镜脾切除术后的镇痛需求（7[标准差3]对11[6]；p<0.01）和术后住院时间（3.8[2.6]对7.4[3]天；p<0.01）明显更短。脾切除术后，腹腔镜脾切除术组72%的患者和开放手术组78%的患者血小板计数恢复正常。平均随访20个月和63个月后，每组各有1例患者出现远期并发症。
与开放手术相比，腹腔镜脾切除术具有更好的近期临床效果，长期结果相似。
