• 廣東省茂名市人民醫(yī)院普外二科（茂名525000）;

目的 　探討腹腔鏡下脾切除術（LS）治療特發(fā)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(shù)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(xù)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(shù)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(jīng)t檢驗，差異均有統(tǒng)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。

引用本文： 陳斌. 腹腔鏡脾切除治療特發(fā)性血小板減少性紫癜20例. 中國普外基礎與臨床雜志, 2009, 16(10): 810-811. doi: 復制

1. 沈迪主編. 臨床血液學 [M]. 北京: 人民衛(wèi)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(fā)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. 1. 沈迪主編. 臨床血液學 [M]. 北京: 人民衛(wèi)生出版社, 1989: 713-714.
  2. 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(fā)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. 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. 4. Carroll BJ, Phillips EH, Semel CJ, et al. Laparoscopic splenectomy [Ｊ]. Surg Endosc, 1992; 6(4): 183-185.
  5. 5. Zoring C, Emnermann A, Hegewish S, et al. Laparoscopic splenectomy for idiopathic thrombocytopenic purpura [Ｊ]. Deulsche Medizin, 2001; 126: 325-328.
  6. 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. 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. 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. 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. 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. 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. 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.