Abstract: Objective:To investigate the clinical efficacy of laparoscopic splenectomy (LS) for immune thrombocytopenic purpura (ITP).
Methods:The clinical data of 84 patients with ITP who underwent LS at the First Affiliated Hospital of Chongqing Medical University from January 2007 to January 2014 were retrospectively analyzed. The potential prognosing indexes (gender, age, course of diseas, preoperative response to steroid, preoperative PLT, operation time, volume of intraoperative blood loss and postoperative PLT peak within 7 days) were collected and analyzed. The evaluation of surgical efficacy was done according to the American Society of Hematology 2011 evidencebased practice guideline for ITP. The complete response and partial response were defined as effective and no response as void. All of the patients were followed up by outpatient examination and telephone interview till December 2014, the followup information included platelet count, bleeding performance, presence of longterm complications and postoperative recurrence, etc. Measurement data with normal distribution were presented as ±s, and skew distribution data were described as M (range). The postoperative longterm effective rate was analyzed by KaplanMeier method. The univariate analysis and multivariate analysis were done using the chisquare test and Logistic regression model, respectively.
Results:The operation time of 84 patients was (154±40)minutes with a median volume of intraoperative blood loss as 200 mL (10-1 000 mL). Lienculus was detected in 11 patients and resected. Seven patients had complications and recovered after symptomatic and supportive treatment. There was no perioperative death. Among the 84 patients who were followed up for an average followup time of 51 months (1²-96 months), 45 patients had complete response, 18 patients had partial response and 21 had no response, without serious spontaneous visceral and intracranial hemorrhage. Eighteen partialresponse patients underwent symptomatic medical therapy and 21 noresponse patients took orally prednisolone, among which 13 had PLT>30×109/L stably. During the followup, only one completeresponse patient died of lung cancer with systemic metastasis at 2 years after surgery. Four patients had pneumonia, 1 noresponse female patient had pyothorax repeatedly for a long time, and they all recovered after symptomatic and supportive treatments. There were no serious complications and overwhelming postsplenectomy infection in other patients. The 1, 3, 5, 7year effective rates were 82.1%, 77.6%, 72.5% and 67.9%, respectively. Univariate analysis showed that preoperative response to steroid, preoperative PLT and postoperative PLT peak within 7 days were related factors affecting longterm effecacy of patients with ITP (χ²=5.600, 6.006, 21.733, P<0.05), but gender, age, course of disease, operation time and volume of intraoperative blood loss were not related factors affecting longterm effecacy of patients with ITP (χ²=0.018, 2.684, 0.000, 0.064, 0.397, P>0.05). Multivariate analysis showed that preoperative response to steroid and postoperative PLT peak within 7 days≥300×109/L were independent protective factors affecting longterm efficacy (OR=5.426, 19.454, 95% confidence interval: 1.220-24.129, 4.704-80.449, P<0.05).
Conclusions:LS is safe and feasible for the treatment of ITP with a high longterm effective rate. Preoperative response to steroid and postoperative PLT peak within 7 days may be the predictors of LS for ITP.