2种方法在治疗特发性血小板减少性紫癜长期疗效的对比

摘要

目的：对比分析腹腔镜脾切除术与开腹脾切除术治疗特发性血小板减少性紫癜的围手术期结果及长期疗效。方法回顾性分析2011年1月至2015年1月该院肝胆外科124例特发性血小板减少性紫癜患者行脾切除术治疗（其中腹腔镜脾切除术68例，开腹脾切除术56例）的临床资料与随访结果。结果腹腔镜脾切除术组手术时间较开腹脾切除术组长，住院时间短，术中失血量少，术后疼痛轻，术后拔出引流管时间短，术后并发症发生率低。腹腔镜脾切除术组术后无下肢深静脉血栓（DVT）发生；开腹脾切除术组术后1例发生 DVT。腹腔镜脾切除术组术后1例死于肺部感染。腹腔镜脾切除术组平均随访时间（33±11．8）个月，开腹脾切除术组平均随访时间（32±12．9）个月，腹腔镜脾切除术组中术后长期有效率为73．5％，开腹脾切除术组中术后长期有效率为76．7％（P ＞0．05）。Kaplan-Meier 分析显示，2组无复发生存率差异无统计学意义（P ＝0．697）。结论腹腔镜脾切除术治疗特发性血小板减少性紫癜的长期疗效与开腹脾切除术相当，但具有非常明显的微创优势。%Objective To compare the perioperative outcomes and long-term therapeutic response of laparoscopic splenectomy versus open splenectomy for idiopathic thrombocytopenic purpura.Methods A retrospective analysis of 124 patients who under-went splenectomy(68 LS and 56 OS)for ITP between January 2011 and January 2015 was conducted.Results Patients undergoing LS were found to require a longer operative time(P <0.05 )but had reduced hospital stay,lower intra-operative blood loss(P <0.05),less postoperative pain,earlier drain removal,and decreased incidence of complications(P <0.05).Conversion to OS was re-quired in 4 patients for excessive loss of blood(5.8%).Deep venous thrombosis(DVT)was observed in 1 patients after OS.One pa-tient died from pneumonia after LS.Mean follow-up of (33±11.8)months was performed in LS group and of (32±12.9)months in OS group.50 patients(73.5%)in LS group and 43(76.7%)in OS group reached sustained complete haematological response(P >0.05).Kaplan-Meier analysis showed that there was no significant difference in the relapse-free survival rate between the groups (P =0.679).Conclusion Compared with open splenectomy,laparoscopic splenectomy for patients with ITP has similar long-term therapeutic response,but it has advantages of minimally invasiveness.