Marassi A, Vignali A, Zuliani W, Biguzzi E, Bergamo C, Gianotti L, Di Carlo V
IRCCS San Raffaele, Department of Surgery, University of Milan, Italy.
Surg Endosc. 1999 Jan;13(1):17-20. doi: 10.1007/s004649900889.
This study aimed to compare the safety, efficacy, and clinical benefits of laparoscopic splenectomy (LS) to open splenectomy (OS) in patients with idiopathic thrombocytopenic purpura (ITP).
The results from 14 consecutive patients who underwent LS for ITP were reviewed and compared with the results from patients who underwent OS for the same disease. Demographics, concomitant disease on admission, and platelet counts were evaluated, as were details of the surgical procedure, postoperative physiologic status, and hospital stay.
Mean operative time was 88.3 min for OS and 146.4 min in LS group (p < 0.05). The conversion rate to open splenectomy was 7.1. Therapeutic response to splenectomy was 92.8% in the LS group and 86.6% in the OS group. Bowel canalization, return to liquid diet, and length of hospital stay were all significantly delayed in the OS group as compared with those who underwent LS (p = 0.01, p = 0.02, p = 0.005, respectively). In the OS group the morbidity rate was 13.3%, whereas in the LS group it was 7.1%.
Laparoscopic splenectomy represents a valid alternative to conventional splenectomy in the treatment of ITP.
本研究旨在比较腹腔镜脾切除术（LS）与开放性脾切除术（OS）治疗特发性血小板减少性紫癜（ITP）患者的安全性、有效性及临床益处。
回顾了连续14例因ITP接受LS治疗的患者的结果，并与因同一疾病接受OS治疗的患者的结果进行比较。评估了人口统计学资料、入院时的伴随疾病及血小板计数，以及手术过程细节、术后生理状态和住院时间。
OS组的平均手术时间为88.3分钟，LS组为146.4分钟（p<0.05）。转为开放性脾切除术的比例为7.1%。LS组脾切除术后的治疗反应率为92.8%，OS组为86.6%。与接受LS的患者相比，OS组的肠道通气、恢复流食及住院时间均显著延迟（分别为p=0.01、p=0.02、p=0.005）。OS组的发病率为13.3%，而LS组为7.1%。
在ITP治疗中，腹腔镜脾切除术是传统脾切除术的有效替代方法。
