【摘要】 目的总结腹腔镜脾切除术(LS)治疗特发性血小板减少性紫癜(ITP)临床疗效和血小板的各参数变化规律。方法选择21例LS治疗的ITP患者,统计手术时间、术中出血量、手术并发症发生率及病死率、随访结果。自身对比手术前后血小板计数、血小板压积、血小板平均容积、血小板分布宽度。结果平均手术时间1.5h,术中出血平均60mL,所有患者穿刺孔周围出现不同程度瘀斑,无创口延期愈合或不愈合。副脾发现率为19%。手术并发症发生率为4.8%。术后平均住院5d(4~7d),无死亡病例。血小板计数、血小板压积呈现波动性上升,血小板平均容积、血小板分布宽度呈现波动性下降。各项参数存在多点动态平衡呈现波动性调节和协同恢复过程。全部患者随访1.5~5.5年,均无复发,血小板相关抗体均在正常范围,骨髓像正常。结论根据血小板各参数恢复过程中存在的多点动态平衡呈现波动性调节和协同恢复过程选择相应的治疗方案,LS治疗ITP更加安全、有效。更多还原

【Abstract】 Objective To evaluate the therapeutic efficacy of laparoscopic splenectomy (LS) for patients with idiopathic thrombocytopenic purpura (ITP) and to investigate the change of parameters of platelets.Methods Twenty-one patients with ITP after LS were studied, including the following paramenters: the operation time, intraoperative blood loss and postoperative complications, and compared perioperative platelet count(PC), packed platelet volume(PPV), mean platelet volume(MPV), and platelet distribution width (PDW) with the postoperative results.Results The mean operation time was 1.5 h. Intraoperative mean blood loss was 60 mL, postoperative hospitalization time was 5 d and with no case of delayed healing of incision. Accessory spleen was found in 19 % of patients . The incidence of complication was 4.8 %, and with no deaths. Platelet count and packed platelet volume increased with fluctuation, but mean platelet volume and platelet distribution width decreased with fluctuation. The parameters were in multipoint dynamic equilibrium with fluctuation and coordinated restoration. All patients were followed-up. No case had recurrence at 1.5~5.5 y, and platelet-associated antibody was in normal range. Bone marrow examination was normal.Conclusions The treatment of ITP with LS is safe and effective. The selection of therapeutic plan should depend on the changes of platelet parameters.更多还原