【摘要】 目的探讨腹腔镜脾切除(LS)治疗特发血小板减少性紫癜(ITP)的疗效。方法回顾分析采用腹腔境行脾切除治疗25例ITP患者的临床资料。结果所有ITP患者顺利施行LS,包括2例辅助小切口LS,无手术死亡、感染等严重并发症。平均随访3.5年(1~7年),脾切除术后有效率80.0%(20/25例),2年有效率72.0%(18/25例),其中包括2例激素治疗出现胃溃疡大出血导致重度贫血及激素副作用的ITP患者。分析显示脾切除效果与患者年龄有关,≤50岁脾切效果明显优于>50岁的患者(P<0.05)。术后随访发现脾切术后第7天血小板计数与术后2年复查血小板计数相一致,术后第7天平均血小板计数在脾切除有效者为307×109/L,明显高于脾切除无效的103×109/L(P<0.05)。患者病程、激素治疗是否敏感、术前血小板计数均与脾切除疗效无关(P>0.05)。结论腹腔镜脾切除治疗特发性血小板减少性紫癜安全、可行并且有效,对年龄小于50岁、激素治疗无效或需大剂量激素治疗ITP患者宜积极行腹腔境脾切除术;脾切除时患者年龄、术后第7天血小板计数可能是判断脾切除效疗的有用指标。更多还原

【Abstract】 Objective To study the predictive factors of effect on idiopathic thrombocytopenic purpura(ITP) after laparoscopic splenectomy(LS).Methods The clinical records of 25 patients with ITP treated by LS during Jan.2000 to Oct.2007 were retrospectively analyzed.Results There was no mortality or severe complication during LS.All these patients were successfully operated by LS,including 2 cases operated by LS assisted with short incision.The median follow-up was 3.5 years(1～7years),The postoprative remission rate was 80%(20/25),and the 2-year remission rate was 72%(18/25),including 2 remission patients who had severe anemia from a bleeding gastric ulcer and side effects of high dose and long-term corticosteroid treatment before LS.Multivariated analyses showed younger patients(≤50 y) responded more positively than older patients(>50 y) to LS(P<0.05).Likewise,platelet counts on 7th postoperative day coincided with those at 2-year follow up.Average platelet counts in remission and no remission patients with ITP were 307×109/L and 103×109/L on 7th postoperative day respectively(P<0.05).Conclusions LS is a safe and effective therapy for patient with ITP.Young Patients(≤50 y) with need high dose of corticosteroids or are resistant to corticosteroids should undergo LS.Age at surgery(≤50 y) and platelet counts on 7th postoperative day might predict the effect of laparoscopic splenectomy.更多还原