| OBJECTIVE:Compare the clinical results of laparoscopic splenectomy(LS) and open splenectomy(OS) in patients with idiopathic thrombocytopenic purpura (ITP)to summarize the clinical application of laparoscopic splenectomy(LS),Study the feasibility,efficiency,safety,advantages and disadvantages of laparoscopic splenectomy(LS).METHODS:Retrospectively analyse the clinical record of 60 ITP patients who were treated by laparoscopic splenectomy(LS) or open splenectomy(OS) since March 1997 to December 2008 in the Second Hospital of Shandong University and Qilu Hospital of Shandong University:Laparoscopic splenectomy(LS) were performed in 42 cases, Open splenectomy(OS) were performed in 18 cases.We collected and compare the datas in the both groups of the age composition,the gender composition,the rate of the patients who received gamma globulin, the rate of the patients who used the immunosuppressor, the platelet number before operation,the composition of patients who was steroid dependent or steroid resistant,the operative time, the intraoperative blood loss,the intraoperative accessory spleen present rate,the perioperative mortality,the oral food recover time,the rate of patients required analgesic after operation,the postoperative hospital stay, the postoperative complication rate,hospitalization cost and the postoperative total treatment effectiveness. Use the SPSS 16.0 software for statistical analysis to analyse, the Student T- test was used to evaluate the mean comparison in groups,the X~2-test was used to evaluate the rate comparison in groups,significance levelαis 0.05. RESULTS:1.The comparision of LSG and OSG before operation:The mean patients' age was (29.0±9.7)years for LS and (29.2±9.2)years for OS, which had no statistical significance between the group (t =0.057, P>0.05); The gender composition(male/female) was (13 / 29) for LS and (6 / 12) for OS, which had no statistical significance between the group (X~2=0.033, P>0.05); The rate of the patients who received immunosuppressant was 30%(13 / 42) for LS and 38.9%(7 / 18) for OS, which had no statistical significance between the group (X~2=0.015, P>0.05); The rate of the patients who received gamma globulin was 23.8%(10 / 42) for LS and 16.7% (3 / 18) for OS, which had no statistical significance between the group (X~2=0.252, P>0.05); The platelet number before Operation was (43.5±31.1)×10~9 /L for LS and (45.3±23.2)×l0~9 / L for OS, which had no statistical significance between the group (t =0.176, P>0.05); The composition of patients who was steroid dependent versus steroid resistant was (9 / 33) for LS and (4 / 14) for OS, which had no statistical significance between the group (X~2=0.001, P>0.05).2.The comparision of LSG and OSG after operation:There was no perioperative mortality in LSG, and conversion to open surgery was required in 3 cases. All operation were successful in OSG,and there was no perioperative mortality in OSG;The operative time was (214.5±55.0)minutes in LS and (119.5±12.8)mimutes in OS,which had statistical significance between the groups(t=5.845,P<0.01);The estimated intraoperative blood loss was (161.2±104.1)ml in LS and (289.5±81.0)ml in OS,which had statistical significance between the groups(t=3.647,P<0.05); The present rate of accessory spleen was 14.3 % (6/42) in LS and 11.1 % (2/18) in OS, which had no statistical significance between the group(X~2= 0.001 , P>0.05); The Time to liquid food intake was (2.0±0.7)days in LS and (3.2±1.2)days in OS,which had statistical significance between the groups(t=3.528,P<0.05);The rate of required analgesics after operation was 35.7% (15/42) in LS and 72.2% (13/18) in OS, which had statistical significance between the group(X~2=4.447, P<0.05);The postoperative hospital stay was (5.1±1.3)days in LS and (13.1±3.0)days in OS,which had statistical significance between the groups(t=10.24, P<0.01); The hospitalization cost was 17508.65±2811.3 Renminbi yuan in LS and 111 24.40±1319.98 Renminbi yuan in OS,which had statistical significance between the groups(t=3.886,P<0.05); The intraoperative and post operative complication rate was 19.1 % (8 / 42) in LS and 27.8 % (5/18) in OS, which had no statistical significance between the group(X~2= 0.310, P>0.05);The treatment effectiveness was 85.7% (36 / 42) in LS and 88.9% (16/ 18) in OS, which had no statistical significance between the group (X~2= 0.001, P>0.05).CONCLUSIONS:There is no statistical significance between the two groups after treatment.But the laparoscopic splenectomy has the characters of minimally invasion: less trauma ,few blood loss,short admitting time and quick recovery.The laparoscopic splenectomy is a safe effective and feasible therapy method.Camparing with the open splenectomy ,The disadvantages of the laparoscopic splenectomy are longer operative time and more expensive. |
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