Primary thrombocytopenic purpura (ITP) is an acquired organ-specific autoimmune disease that is caused by the production of anti-platelet autoantibodies in the body leading to excessive destruction of platelets by the monocyte-macrophage system, resulting in thrombocytopenia. Laparoscopic splenectomy (LS) has the advantages of less trauma, more beautiful incision, less postoperative pain and shorter average hospital stay compared with traditional splenectomy. From April 2007 to December 2008, two patients with thrombocytopenic purpura were admitted to our department and underwent successful laparoscopic splenectomy with satisfactory results after careful preoperative and postoperative care. The clinical data are as follows: 1. The age was 67 years old for male and 54 years old for female. The clinical manifestations were bleeding, both with skin petechiae, gingival bleeding and nasal bleeding, and one case with positive fecal occult blood, preoperative diagnosis: idiopathic thrombocytopenic violet epilepsy, one case of hypersplenism combined with anemia, preoperative ultrasound and CT examination, two cases of mild splenomegaly (upper and lower diameter less than 15 cm). 2 cases of LS were successful, the operation time was 180 and 300 min, the average 245 min. Intraoperative bleeding was 150ml and 350mL, and the gastric tube was removed one day after surgery, and the longer surgery was removed within two days after surgery, and a liquid diet was started one day after surgery. The patients were hospitalized for 5-7 d after surgery, with an average of 5.8 d. All of them recovered and were discharged. All patients had different degrees of platelet reduction before surgery, 23.6×109/L, and the platelets increased to different degrees on the third day after surgery, 125.7×109/L. 2. Preoperative care LS is a new treatment for spleen disease carried out in recent years, which is not yet popular in China, and patients and their families have little understanding of this procedure and may have doubts about the safety and efficacy of the surgery. For this reason, we patiently and meticulously tell patients and their families about the indications, methods, advantages and disadvantages and clinical development of IS before surgery to relieve patients’ worries and concerns, gain their full trust and actively cooperate with the treatment. Routinely do electrocardiogram and chest X-ray to understand whether there are any abnormalities in cardiopulmonary function, and check blood routine, coagulation time and prothrombin time, platelet count to understand the patient’s coagulation mechanism. Prepare 400-800mL of blood one day before surgery. For patients with thrombocytopenia that is difficult to correct, plasma exchange or direct transfusion of platelet suspension can be used to increase the platelet count. Prepare the skin of the operation area according to the routine, especially clean the umbilical skin thoroughly. Because laparoscopic surgery requires puncture of the umbilicus or the periumbilical area to establish the operating hole, it is important to thoroughly clean the umbilical area and to ensure that the skin inside the umbilicus is intact. Preoperative fasting for 12 h and water fasting for 4-6 h. Soap and water enema of 500 mL was given in the evening before surgery to empty the stool. In the morning of surgery, gastric tube and urinary catheter were placed. For patients with more severe esophagogastric fundic varices, patients were instructed to take 10ML liquid paraffin oil orally before placing the gastric tube, and the front end of silicone gastric tube was lubricated with paraffin oil and then gently inserted into the stomach to prevent rupture and bleeding of esophagogastric fundic vein. 3.Postoperative care for those who are not awake from general anesthesia, lie down with head tilted to the side. Give continuous low-flow oxygen, oxygen flow rate is 3 liters/min. Fasting, abstaining from drinking, removing the gastric tube one day after surgery, removing the gastric tube within 48-72h if the gastrointestinal function recovery time is longer, and starting to eat liquid diet 48h after surgery. Postoperatively, the changes of vital signs were closely observed, and blood pressure, pulse and respiration were monitored every 15-30 min, which could be changed to once every 2 h after the condition was stabilized. Observe the condition of consciousness, consciousness, oxygen saturation, facial color, peripheral circulation, abdominal wound and drainage tube. Ensure that all kinds of tubes are usually in place, especially to avoid folding, twisting and blockage of the drainage tube at the splenic fossa, and pay attention to the volume and nature of the drainage fluid. If the flow of drainage is more than 100mL per hour, internal bleeding should be considered as a possibility and the doctor should be notified immediately. The abdominal drainage tube is usually removed 2 to 3 d after surgery. Prevention of postoperative complications: ①Intra-abdominal bleeding: closely observe the patient’s vital signs, abdominal signs, peripheral blood circulation, and the condition of the drainage fluid in the drainage tube. If abnormalities are found, notify the surgeon promptly and be prepared for reoperation if necessary. ②Fever: After splenectomy, the immune function and anti-infection ability of the body are reduced, which can easily cause fever due to splenic fever, postoperative reaction fever, bacterial infection and complications, which directly endanger the life of the patient [2]. Therefore, the body temperature of patients after splenectomy should be closely observed. The temperature should be measured four times a day after surgery to observe the presence of fever and the duration of fever, and physical and pharmacological cooling should be given in a timely manner, with regular blood tests and reasonable use of antibiotics. (3) Thrombosis: closely monitor the changes of platelets after surgery, and be alert when there is abdominal pain, swelling and pain in the lower limbs or sudden respiratory distress to prevent the occurrence of venous thrombosis, and use anticoagulant drugs as appropriate when platelets increase above 400×109/L. 4.Discharge instruction Explain to patients and family members that after discharge, regular monitoring of blood routine, observation of platelet and hemoglobin changes, reasonable diet, work and rest, prevention of cold and flu, regular review and follow-up.