| Idiopathic thrombocytopenic purpura (ITP) is a kind of immune disease, that anti-platelet antibodies induce to the platelets'immune destruction, and decrease platelets in the blood, and the whole body is prone to hemorrhage. Platelet associated Igs (PAIg), mostly IgG, are produced in liver and spleen, more in the spleen, what's more, platelets are destroyed in splenic sinusoid. Therefore, splenectomy can remove the place that produces the antibodies and destroies platelets, then the number of platelets in the blood will increase. It is reported that the total efficiency of ITP is 88% after 1 month of the splenectomy, and 74% after 1 year, even the ones that have no reaction to the operation will get a low level of glucocorticoid.There is a history of 120 years to resecting the spleen of the patients with hematological diseases. Most of the hematological patients have no reaction to the treatment of traditional Chinese drugs, glucocorticoid, and r-Globulin, and then the splenectomy is the only effective way. Whatever, most patients hesitate because of their fear of surgery. As the maturation of technology of laparoscopic splenectomy (LS), splenectomy has a wide clinical application in the hematological diseases. Patients with ITP, hereditary spherocytosis (HS), or autoimmune hemolytic anemia (AHA) receive effective clinical results after the surgery, while get ineffective results with medical treatment. Katkhouda thought, we should perform LS on the younger ITP patients as early as possible, to avoid the side effects of glucocorticoid.We have successfully performed 7 cases of LS in the First Hospital of Jilin University, and received satisfied effect. To compare the security, efficiency and superiority between LS and open-splenectomy (OS), We have retrospectively analyzed the clinical results of these cases of LS and other 6 cases of OS in the First Hospital of Jilin University from January 2006 to January 2007. The ITP patients were divided into 2 groups according to the modus operandi: group LS, 7 cases, 1 is male, 6 are female, the ages are 22-57, the average age is 36.4±11.5; group OS, 6 cases, 1 is male, 5 are female, the ages are 23-56, the average age is 44.2±6.9. There are no statistical differences between two groups in the distribution of ages, gender, and the body condition. The surgeries were all successfully finished. In the LS group, the sum of platelets increased gradually to the normal level after the LS, but there was only 1 patient whose platelets decreased again 2 weeks after the surgery, the effective-respond rate was 85.7%; in the OS group, the platelets didn't increase in only 1case, and the effective-responding rate was 83.3%, and the difference had no statistical significance (χ2=0.147, P >0.05). LS owns the same security with OS, in the 7 cases of LS, the surgeries were successful, no side injury was happened. The operation time were (87.1±21.4) min和(90.8±25.8) min (t=0.283, P= 0.783) separately in the LS and OS group, and there was no significant difference. The volume of hemorrhage in the surgery were (85.7±58.3) ml and (176.7±65.9) ml,(t=2.642, P=0.023), separately in the two groups, and the LS group was lower than the OS group; In the LS group, the patients could take food after (1.14±0.38) days of the surgery in average, while the OS group did it after (2.33±0.52) days,(t=4.795, P=0.001); In the LS group, the patients could walk after (1.29±0.49) days of the surgery in average, while the OS group did it after (2.17±0.41) days, (t=3.492, P=0.005); the hospitalization time were separately (7.86±1.35) days and (14.17±7.28) days in average, (t=2.265, P=0.045). That's to say, the patients can recover soon and suffer little with LS. The expense of the two groups were separately (16800.0±4567.2) RMB and (21878.3±3003.5) RMB, (t=2.320, P=0.041), the LS group was lower than the OS group, which is different from other reports. And it benefits from the LigaSure two-step mutilation of the second pedicel of the spleen, as a result, the patient can conserve about 5000 yuan.The main complication of the splenectomy was hemorrhage during and after the surgery, while the 13 cases in the two groups didn't bleed There are some other complications such as pancreas fistula, hemorrhage caused by low platelet, and the infection induced by using glucocorticosteroid. Some articles reported that the morbidity of abcess under diaphragm and lung infection can reach to 13.46% and 18.87% after the splenecotomy in the hemotologic patients treated by glucocorticosteroid. In our research, in the OS group, 1 case got incision infection, 1case had hydrops in the splenic space, and after the treatment they both recovered, no complications occured in the LS group. Although no statistical difference was observed between the two groups (P>0.05), the LS has lower probability of complication than the OS. The using of analgesic drugs was obviously less in the LS, there was one case need the analgesic in LS and 3 cases in OS. So we have the conclusion as follows: 1. LS has the same curative effect with the OS in the ITP treatment. 2. LS has the same security as OS, the LS performed on 7cases in this group were successful and none of them had side-injury or turn to the OS in the surgery. 3. LS has a lot of superiority, the operating time was reduced, the effect was satisfactory, and could obviously decrease the cost of hospitalization. LS is an effective treatment which can replace the OS completely. |
