【摘要】 【目的】探讨腹腔镜脾切除术(LS)治疗皮质激素治疗无效型(SR)和激素依赖治疗型(SD)的免疫性血小板减少性紫癜(ITP)的结果。【方法】回顾性分析1999年9月至2008年2月期间129例成功完成LS的ITP患者的临床资料,并分为SR组(82例)与SD组(47例),比较两组的治疗结果。统计方法中率的比较采用χ2检验,均数比较采用Studentt检验。【结果】129例患者并发症发生率为9.3%,1例SR型患者因术后腹腔感染、败血症而死亡。血液学疗效:79.1%患者完全显效(CR),10.1%部分显效(PR),10.8%无效(NR)。SR组与SD组患者术前1d血小板计数分别为(90±66)×109/L和(124±69)×109/L(P<0.05),手术时间分别为(120±46)min和(121±45)min(P>0.05),术中出血量分别为(83±145)mL和(95±288)mL(P>0.05),术后48h总引流量分别为(106±148)mL和(65±67)mL(P<0.05),并发症发生率分别为9.7%和8.5%(P>0.05),术后7d血小板计数分别为(340±215)×109/L和(426±264)×109/L(P<0.05)。血液学疗效:SR组CR70.7%,PR12.2%,NR17.1%,而SD组CR93.6%,PR6.4%,两组间差异有统计学意义(P<0.05)。【结论】LS治疗ITP具有良好的疗效。在术前准备妥当的情况下,SR型患者手术安全性与SD型相近,但其总体血液学疗效明显差于后者。更多还原

【Abstract】 【Objective】To investigate the outcomes of laparoscopic splenectomy (LS) for the patients with steroid-resistant (SR) or steroid-dependent (SD) immune thrombocytopenic purpura (ITP). 【Methods】 Clinical data of 129 ITP patients undergoing successful LS between September 1999 and February 2008 were analyzed retrospectively. The patients were divided into SR group (n=82) and SD (n=47) group and the outcomes were compared. Chi square test and Student′s t-test were used to compare the frequencies and means in statistical analysis, respectively. 【Results】 The morbidity rate was 9.3% in 129 patients. One case of SR ITP died from postoperative abdominal infection and sepsis. The complete response (CR), partial response (PR), and no response (NR) were 79.1% , 10.1% , and 10.8% , respectively for hematological outcomes in all patients. The platelet counts 1 d before operation were (90 ± 66) ×109/ L in SR group and (124 ± 69) × 109/ L in SD group (P<0.05). Mean operative time was (120 ± 46) min for SR group and (121±45) min for SD group (P>0.05). Estimated intraoperative blood loss was (83 ± 145) mL and (95 ± 288) mL for SR group and SD group (P>0.05). Estimated 48-hour volumes of postoperative drainage were (106±148) mL and (65±67) mL, respectively (P<0.05). The complication rates were 9.7% and 8.5% for SR group and SD group (P>0.05). The platelet counts 7 d after the operation were (340 ± 215) ×109/ L and (426±264) × 109/ L, respectively (P<0.05). In SR group, 70.7% achieved CR, 12.2% achieved PR, and 17.1% achieved NR, while 93.6% achieved CR and 6.4% with PR in SD group. There were statistically significant differences in hematological outcomes between the two groups (P<0.05). 【Conclusions】 LS provides excellent therapeutic outcomes for ITP. With correct preoperative medical preparation, the safety of LS for SR patients is close to that for SD patients, while the overall hematological outcomes of SR patients are significantly worse than those of SD patients.更多还原