The Influence Of Low Platelet Counts For The Feasibility And Therapeutic Effect Of Laparoscopic Splenectomy

BackgroundImmune thrombocytopenic purpura(ITP) is a kind of disease caused by the dysfunctional immune system, which lead to the destroy and decrease of platelet. The primary therapy for ITP is medical treatment. And for the patients who have no response to the medical therapy, splenectomy becomes the first choice. Since Delaitre et. al reported the first case of laparoscopic splenectomy in 1991, it turned into the golden standard for the therapy of ITP on account of the less trauma, faster recovery and lower rate of infection.Surgeons pay more attention to the feasibility and efficacy of Laparoscopic splenectomy because of the reduction of preoperative platelet counts to varying degrees. Masses of researches have demonstrated that LS is safe and feasible for patients with PLT> (30-50) ×109/L. Nevertheless, there are few reports for patients whose PLT are less than 30×109/L, especially less than 10×109L. In our study, we reviewed 76 ITP cases undergoing laparoscopic splenectomy in our department from January 2010 to December 2014. Three groups were divided based on the preoperative counts of PLT. Then we discussed the feasibility and efficacy of Laparoscopic splenectomy for the patients with lower platelet counts by comparing the surgical index and hematological outcomes of three groups.ObjectiveTo investigate the influence of low preoperative platelet counts for the feasibility and efficacy of Laparoscopic splenectomy (LS).MethodTo retrospectively analyse the database of 76 ITP patients from January 2010 to December 2014. Considering the guidelines of ITP, three groups, A (0-10)×109/L, B (10-30)×109L, C(>30×109L), were divided based on the preoperative platelet counts. Surgical outcomes, including the operating time, the intraoperative blood loss, postoperative hospital stay and the postoperative complication were compared between three groups after LS. And hematological outcomes were compared at the time point of 3,6,12 months after the surgeries.ResultAll of 76 operations were successful. The mean operating time of group A was (198.9±46.2)min, and it was significant compared with group B(135.6±24. lmin) and group C(125.4±30.0)min (P<0.05).The mean intraoperative blood loss of groups A was (182.9±37.3) ml, compared with group B(104.1±21.4) ml and group C(102.1±43.6)ml, there was statistical significance (P<0.01). For the postoperative complication and the mean postoperative hospital stay, there was no significance between three groups(p>0.05). All patients were followed up 3,6 and 12 months after the operation and hematological outcomes were measured. The efficient rate after LS in group A was 42.9%, and it was significant compared with group C (75%) (P>0.1).But compared with group B (64.7%), there was no significance (P<0.05)ConclusionThe low preoperative platelet counts have an effect on the efficacy and postoperative recovery after Laparoscopic splenectomy, but LS is also safe and feasible for ITP cases with low preoperative platelet count.