特発性血小板減少誠紫斑病に対する腹腔鏡下脾臓摘出術の経験  [in Japanese] Laparoscopic Splenectomy for the Patients with Idiopathic Thrombocytopenic Purpura  [in Japanese]

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Abstract

特発性血小板減少性紫斑病(以下,ITPと略記)の2例に対し腹腔鏡下脾摘術を施行したので報告する.症例は63歳の男性と57歳の女性で,いずれも内科療法にて副作用の合併したITPの患者である.手術:体位を右斜め側臥位とし,5本のトロッカーを挿入した.まず脾外側の腹膜を切開し,脾結腸間膜を脾に沿って切離した.次に胃脾間膜と膵脾間膜を脾に沿って徐々にEndo-Clip,Endo-Scissors,Endo-GIAを用いて脾臓を摘出した.脾臓はEndo-pouchに収納し,創を広げることなく砕いて腹腔より摘出した.出血量は190mlと200mlで,手術時間は3時間35分と3時間05分であった.ITPにおいて腹腔鏡下脾臓摘出術はステロイド療法に比べ副作用,入院期間などはるかに優れており,寛解率も良く,また疾患としても若い女性に多いことより美容的にも優れており,治療方針として積極的に選択すべき方法と思われる.

We report two patients with idiopathic thrombocytopenic purpura (ITP) who underwent laparoscopic splenectomy. The platelet count rose following the administration of an immunosuppressant agent or a high dose of gammaglobulin, and autologous blood was donated preoperatively. In the right oblique lateral position under general anesthesia, a total of 5 trochars were inserted. First the peritoneal reflexion on the left side of the spleen was incised. Next the splenocolic ligament was separated close to the spleen. The spleen was resected by serial dissection of the gastrosplenic ligament and pancreatosplenic ligament close to the spleen with Endo-clip, Endo-scissors, and Endo-GIA. The spleen was packed in an Endo-pouch, crushed, and removed from the abdomen. The splenic bed was inspected for adequate hemostasis. The estimated blood loss was from 190ml to 200ml and mean operation time was 3 hours and 20 minutes. The postoperative course was uneventful in both cases. The advantages of this technique are rapid recovery, minimal incisional discomfort, brief hospitalization, and superior cosmetic results, especially in younger females. In cases of ITP, steroid therapy is considered first and splenectomy or immunosuppressant agents are favored in patients who do not respond to steroid therapy. However, steroid therapy has many side effects, such as peptic ulcers, infection, diabetes mellitus, and osteoporosis. Laparoscopic splenectomy may be the preferred treatment for ITP in the near future.

Journal

  • The Japanese journal of gastroenterological surgery

    The Japanese journal of gastroenterological surgery 27, 2029-2033, 1994

    The Japanese Society of Gastroenterological Surgery

Cited by:  5

Codes

  • NII Article ID (NAID)
    110001349831
  • NII NACSIS-CAT ID (NCID)
    AN00192066
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    03869768
  • Data Source
    CJPref  NII-ELS 
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