Laparoscopic Splenectomy for Idiopathic Thrombocytopenic Purpura in 20 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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陳斌

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特發性血小板減少性紫癜; 脾疾病; 脾切除術; 腹腔鏡

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目的　探討腹腔鏡下脾切除術（LS）治療特發性血小板減少性紫癜(ITP)的臨床效果。
方法　我院2003年1月至2008年8月期間行LS治療ITP患者20例，將術前與術后1、2、7、14、30、90及180 d的血小板計數進行比較。
結果　20例ITP患者均順利完成LS，平均手術時間為156 min，術中出血平均50 ml，平均住院時間為9 d。完全停用藥物14例； 4例患者術后需繼續服用激素治療，但激素用量較前明顯減少；無效2例。總有效率為90%。術后1、2、7、14、30、90及180 d的血小板數量分別為(251.6±91.4)×109/L、(312.6±90.1)×109/L、(343.2±103.7)×109/L、(300.0±98.2)×109/L、(175.6±42.6)×109/L、(151.8±42.1)×109/L及(207.0±53.4)×109/L,分別與術前〔(38.3±19.4)×109/L〕比較，經t檢驗，差異均有統計學意義（P＜0.001）。
結論　LS治療ITP是可行和安全的，手術效果滿意。

Citation： 陳斌. Laparoscopic Splenectomy for Idiopathic Thrombocytopenic Purpura in 20 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(10): 810-811. doi: Copy

1.	沈迪主編. 臨床血液學 [M]. 北京: 人民衛生出版社, 1989: 713-714.
2.	Ruiz-Tovar J, Alonso Hernández N, Pérez de Oteyza J, et al. Laparoscopic vs open splenectomy in the treatment of idiopathic thrombocytopenic purpura [Ｊ]. Cir Esp， 2007; 81(4): 192-196.[３]Pace DE, Chiasson PM, Schlachta CM, et al. Laparoscopic splenectomy for idiopathic thrombocytopenic purpura (ITP) [Ｊ]. Surg Endosc, 2003; 17(1): 95-98. [４]陳萍，胡理明，周奇, 等. 腹腔鏡脾切除治療特發性血小板減少性紫癜 [Ｊ]. 中華血液學雜志, 2003; 24(9): 492-493.[５]Berends FJ, Schep N, Cuesta MA, et al. Hematological lo-ng-term results of laparoscopic splenectomy for patients with idiopathic thrombocytopenic purpura: a case control study [Ｊ]. Surg Endosc, 2004; 18(5): 766-770.
3.	鄭璐，李靖，梁平. 腹腔鏡脾切除術的研究進展 [Ｊ]. 中國普外基礎與臨床雜志, 2005; 12（6）: 574-576.
4.	Carroll BJ, Phillips EH, Semel CJ, et al. Laparoscopic splenectomy [Ｊ]. Surg Endosc, 1992; 6(4): 183-185.
5.	Zoring C, Emnermann A, Hegewish S, et al. Laparoscopic splenectomy for idiopathic thrombocytopenic purpura [Ｊ]. Deulsche Medizin, 2001; 126: 325-328.
6.	Katkhouda N, Hurwitz MB, Rivera RT, et al. Laparoscopic splenectomy: outcome and efficacy in 103 consecutive patients [Ｊ]. Ann Surg, 1998; 228(4): 568-578.
7.	Sampath S, Meneghetti AT, MacFarlane JK, et al. An 18-year review of open and laparoscopic splenectomy for idiopathic thrombocytopenic purpura [Ｊ]. Am J Surg, 2007; 193(5): 580-583.
8.	Shimomatsuya T, Horiuchi T. Laparoscopic splenectomy for treatment of patients with idiopathic thrombocytopenic purpura. Comparison with open splenectomy [Ｊ]. Surg Endosc, 1999; 13(6): 563-566.
9.	Palanivelu C, Jani K, Malladi V, et al. Early ligation of the splenic artery in the leaning spleen approach to laparoscopic splenectomy [Ｊ]. J Laparoendosc Adv Surg Tech A, 2006; 16(4): 339-344.
10.	Keidar A, Feldman M, Szold A. Analysis of outcome of laparoscopic splenectomy for idiopathic thrombocytopenic purpura by platelet count [Ｊ]. Am J Hematol, 2005; 80(2): 95-100.
11.	Ikeda M, Sekimoto M, Takiguchi S, et al. Total splenic vein thrombosis after laparoscopic splenectomy: a possible candidate for treatment [Ｊ]. Am J Surg, 2007; 193(1): 21-25.
12.	Khan LR, Nixon SJ. Laparoscopic splenectomy is a better treatment for adult ITP than steroids—it should be used earlier in patient management. Conclusions of a ten-year follow-up study [Ｊ]. Surgeon, 2007; 5(1): 3-4, 6-8.

1. 沈迪主編. 臨床血液學 [M]. 北京: 人民衛生出版社, 1989: 713-714.
2. Ruiz-Tovar J, Alonso Hernández N, Pérez de Oteyza J, et al. Laparoscopic vs open splenectomy in the treatment of idiopathic thrombocytopenic purpura [Ｊ]. Cir Esp， 2007; 81(4): 192-196.[３]Pace DE, Chiasson PM, Schlachta CM, et al. Laparoscopic splenectomy for idiopathic thrombocytopenic purpura (ITP) [Ｊ]. Surg Endosc, 2003; 17(1): 95-98. [４]陳萍，胡理明，周奇, 等. 腹腔鏡脾切除治療特發性血小板減少性紫癜 [Ｊ]. 中華血液學雜志, 2003; 24(9): 492-493.[５]Berends FJ, Schep N, Cuesta MA, et al. Hematological lo-ng-term results of laparoscopic splenectomy for patients with idiopathic thrombocytopenic purpura: a case control study [Ｊ]. Surg Endosc, 2004; 18(5): 766-770.
3. 鄭璐，李靖，梁平. 腹腔鏡脾切除術的研究進展 [Ｊ]. 中國普外基礎與臨床雜志, 2005; 12（6）: 574-576.
4. Carroll BJ, Phillips EH, Semel CJ, et al. Laparoscopic splenectomy [Ｊ]. Surg Endosc, 1992; 6(4): 183-185.
5. Zoring C, Emnermann A, Hegewish S, et al. Laparoscopic splenectomy for idiopathic thrombocytopenic purpura [Ｊ]. Deulsche Medizin, 2001; 126: 325-328.
6. Katkhouda N, Hurwitz MB, Rivera RT, et al. Laparoscopic splenectomy: outcome and efficacy in 103 consecutive patients [Ｊ]. Ann Surg, 1998; 228(4): 568-578.
7. Sampath S, Meneghetti AT, MacFarlane JK, et al. An 18-year review of open and laparoscopic splenectomy for idiopathic thrombocytopenic purpura [Ｊ]. Am J Surg, 2007; 193(5): 580-583.
8. Shimomatsuya T, Horiuchi T. Laparoscopic splenectomy for treatment of patients with idiopathic thrombocytopenic purpura. Comparison with open splenectomy [Ｊ]. Surg Endosc, 1999; 13(6): 563-566.
9. Palanivelu C, Jani K, Malladi V, et al. Early ligation of the splenic artery in the leaning spleen approach to laparoscopic splenectomy [Ｊ]. J Laparoendosc Adv Surg Tech A, 2006; 16(4): 339-344.
10. Keidar A, Feldman M, Szold A. Analysis of outcome of laparoscopic splenectomy for idiopathic thrombocytopenic purpura by platelet count [Ｊ]. Am J Hematol, 2005; 80(2): 95-100.
11. Ikeda M, Sekimoto M, Takiguchi S, et al. Total splenic vein thrombosis after laparoscopic splenectomy: a possible candidate for treatment [Ｊ]. Am J Surg, 2007; 193(1): 21-25.
12. Khan LR, Nixon SJ. Laparoscopic splenectomy is a better treatment for adult ITP than steroids—it should be used earlier in patient management. Conclusions of a ten-year follow-up study [Ｊ]. Surgeon, 2007; 5(1): 3-4, 6-8.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Laparoscopic Splenectomy for Idiopathic Thrombocytopenic Purpura in 20 Cases

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