Abstract: Objective To investigate the feasibility and clinical efficacy of laparoscopic splenectomy (LS) for immune thrombocytopenic purpura (ITP) with platelet counts lower than 10×109/L. Methods The clinical data of 17 patients of ITP with platelet (PLT) count lower than 10×109/L, who underwent LS between March 2006 to June 2016 were retrospectively analyzed．There were 8 male cases and 9 female cases in these patients. The mean age was (42.18±15.70) years. Patients were found PLT count < 10×109/L 1 day before surgery, the median course of disease was 2 (1, 5.5) years, and 6 patients were found splenomegaly. Results All 17 patients were successfully underwent LS. The operation time was (156.76±17.90) minutes, median blood loss volume of intraoperative blood loss was 50 (20, 175) mL, and the average hospitalization after surgery was (7.47±1.94) d. The preoperative coagulation functions were normal in all 17 cases. No uncontrol bleeding and postoperative complications occurred in intraoperative and postoperative time. Twelve cases were effectiveness in the short term after LS operation, including 11 cases of complete response and 1 case of partial response. The postoperative effective rate of PLT≥100×109/L was significantly higher than that of PLT < 100×109/L at postoperative 1 d (P＜0.05). There were no significant differences in the postoperative effective rate among different ages, genders, course of disease, whether accompanied by splenic and preoperative immunoglobulin blocking therapy and other factors. Conclusion LS is safe,effective and feasible for the treatment of refractory ITP. For patient with preoperative PLT＜10×109/L, and PLT one day after operation could be an indicator to predict the short-term efficacy of LS for the treatment of ITP.

Key words: blood platelets, splenectomy, laparoscopy, primary immune thrombocytopenia, laparoscopic splenectomy