2002 年 27 巻 6 号 p. 874-879
The surgical technique for idiopathic thrombocytopenic purpura (ITP) and hereditary spherocytosis (HS) has been changing from conventional open splenectomy (OS) to laparoscopic splenectomy (LS).
In this study, we evaluated the usefulness of LS in comparison with OS. The subjects were 15 patients (14 with ITP and 1 with HS) who underwent surgery at our department. OS was performed in 5 patients (OS group), and LS was performed in 10 patients (LS group), of whom 2 underwent hand-assisted surgery. The perioperative parameters evaluated were : operative time, blood loss during operation, splenic weight, accessory spleens identified during operation, and conversion to open splenectomy.The postoperative parameters evaluated were : frequency of pain medication, duration until oral dietintake (days), interval of drainage (days), postoperative stay (days), residual accessory spleens, and complications. Conversion to open splenectomy was not observed in any patient. Blood loss was similar between the OS and LS groups.The operative time was significantly longer (p<0.05) in the LS group (mean, 232 ± 57 minutes) than in the OS group (mean, 155 ± 55 minutes), and the splenic weight was significantly lower (p<0.05) in the LS group (114 ± 86 g) than in the OS group (221 ± 76g). Accessory spleens were identified during operation in only 1 patient in the OS group. The frequency of pain medication was significantly lower (p<0.05) in the LS group (mean, 2.3 ± 1.3 vials) than in the OS group (7.4 ±1.1 vials), and the postoperative stay was significantly shorter (p<0.05) in the LS group (13.0 ± 5.4 days) than in the OS group (22.0 ± 7.1 days).
Evaluation of long-term results 1 year or more after operation showed no change in 3 patients, but no significant differences were observed between LS and OS. LS may be more useful than OS because of better aesthetic results, less invasion, and shorter hospital stay despite some problems such as differences in surgical skills among surgeons and a longer operative time.
