Experimental Study And Clinical Research Of Laparoscopic Splenectomy In Patients With Idiopathic Thrombocytopenic Purpura

Background: Laparoscopic Splenectomy (LS) already remaining 10 years with clinical application, To demand added clinical experience instruct play generalization , cultivate added Doctor of general surgery , that can on top of Laparoscopic Splenectomy. At present, To be short of prospective indicatrixs prognosis of of Laparoscopic Splenectomy (LS) for patients with Idiopathic Thrombocytopenic Purpura (ITP), To demand scheme out simple and precise evaluation systems,.At simul To investigate the relationship between B7-CD28 /CD40-CD154 on spleen mononuclear cell (SMNC) of patients with Idiopathic Thrombocytopenic Purpura (ITP)and diversify for B7-CD28 /CD40-CD154 on peripheral blood mononuclear cell (PBMNC) of Idiopathic Thrombocytopenic Purpura (ITP) were studied after Laparoscopic Splenectomy(LS) as nulli-identify.Objective: To evaluate the therapeutic efficacy of Laparoscopic Spelenctomy (LS) for patients with Idiopathic Thrombocytopenic Purpura (ITP) and to investigate the parameters change of platelet. To investigate the relationship between B7-CD28 /CD40-CD154 on spleen mononuclear cell (SMNC) and peripheral blood mononuclear cell (PBMNC) with flow cytometry (FCM), costimulatory factors and development of Idiopathic Thrombocytopenic Purpura (ITP).Methods: 30 cases of patients with Idiopathic Thrombocytopenia Purpura (ITP) were studied after Laparoscopic Spelenctomy (LS). We noted the operation time, intraoperative blood loss and postoperative complication and compared perioperative Platelet count (PC), packed platelet volume (PPV), mean platelet volume (MPV), platelet distribution width (PDW) with postoperative. Another 10 cases of patients with Idiopathic Thrombocytopenia Purpura (ITP) were studied after Laparoscopic Spelenctomy (LS), The expression level of B7-CD28/CD40-CD154 on spleen mononuclear cell (SMNC) and peripheral blood mononuclear cell (PBMNC) of the patients with Idiopathic Thrombocytopenic Purpura (ITP) was detected by Flow cytometry .Results: The mean operation time was 1.5h. Intraoperative mean blood loss was 60ml. postoperative hospitalization time was 7d with timely healing incision.16.7% of patients have accessory spleen. The incidence of complication was 3.3% with no death case. Platelet count (PC) and packed platelet volume (PPV) increased undulatingly but mean platelet volume (MPV) and Platelet distribution width (PDW) decreased undulatingly. The parameters were in multipoint dynamic equilibrium with undulating accommodation and cooperative restoration. We followed-up all patients, 27 cases of patients with Idiopathic Thrombocytopenia Purpura (ITP) were excellence. The overexpression of B7-CD28 /CD40-CD154 on spleen is likely to be a primary pathophysiological defect in patients with Idiopathic Thrombocytopenia Purpura (ITP). The expression of B7-CD28/CD154-CD40 on spleen were significantly higher in Idiopathic Thrombocytopenia Purpura (ITP) patients compared to controls.Conclusion: Platelet count (PC) and packed platelet volume (PPV) increased undulatingly but mean platelet volume (MPV) and Platelet distribution width (PDW) decreased undulatingly. The parameters were in multipoint dynamic equilibrium with undulating accommodation and cooperative restoration. We followed-up all patients.Bone marrow image was normal. The overexpression of B7-CD28/CD40-CD154 on spleen mononuclear cell is likely to be a primary pathophysiological defect in patients with Idiopathic Thrombocytopenia Purpura (ITP). The expression of B7-CD28/CD154-CD40 on spleen mononuclear cell (SMNC) were significantly higher in ITP patients compared to controls. The treatment to Idiopathic Thrombocytopenia Purpura (ITP) with Laparoscopic Spelenctomy (LS) were all the more safe and effective. The selection of therapeutic plan should depend on the change of the parameters.The study recommend combined therapy give priority to Laparoscopic Spelenctomy (LS) with Idiopathic Thrombocytopenia Purpura (ITP), To come true treatment plan is individualization.