Arnoletti J P, Karam J, Brodsky J
Department of Surgery, Allegheny University of the Health Sciences, Philadelphia, Pennsylvania, USA.
Am J Clin Oncol. 1999 Apr;22(2):114-8. doi: 10.1097/00000421-199904000-00002.
Splenectomy may be indicated in a variety of hematologic diseases for diagnostic reasons, therapeutic reasons, or both. Most reviews reveal a high proportion of procedures performed as part of the staging process for Hodgkin disease. Splenectomy for myelofibrosis has been associated with an increased postoperative complication rate. Other determinants of morbidity have been splenic weight and operative blood loss. The authors reviewed a series of 83 adult patients from a prospective database established in 1991 to determine the incidence of early postoperative complications associated with splenectomy for hematologic disease and to analyze patient characteristics that may predict their occurrence. Morbidity that occurred within 30 days of splenectomy was considered to be an early postoperative complication. Operative estimated blood loss and incidence of postoperative complications were correlated with patient age, preoperative platelet count, splenic weight, and diagnosis of myelofibrosis as regression covariates. Indications for splenectomy were therapeutic in 76 patients (92%). Median splenic weight was 760 g, and 22 patients had massive splenomegaly. Patients with splenic weight more than 1,500 g had a significantly higher median estimated blood loss (300 ml; p = 0.02). Splenic weight was the main determinant of estimated blood loss in a multiple linear regression analysis (p = 0.02). Twenty-two patients (27%) experienced postoperative complications and five of those patients died (6%). Patients with myelofibrosis had the highest incidence of complications (50%) and the highest postoperative mortality (21%; p = 0.04). In a logistic regression model, estimated blood loss was the only variable significantly correlated with postoperative complications (p = 0.02). Splenectomy for hematologic disease is associated with an acceptable early postoperative complication rate, even when the indication is predominantly therapeutic. Patients at particularly high risk include those with elevated operative blood loss, massive splenomegaly, and myelofibrosis.
出于诊断、治疗或两者兼具的原因，脾切除术可用于多种血液系统疾病。大多数综述显示，作为霍奇金病分期过程一部分而进行的手术比例很高。骨髓纤维化患者行脾切除术与术后并发症发生率增加有关。其他发病因素包括脾脏重量和术中失血量。作者回顾了1991年建立的前瞻性数据库中的83例成年患者，以确定血液系统疾病行脾切除术后早期并发症的发生率，并分析可能预测其发生的患者特征。脾切除术后30天内发生的疾病被视为术后早期并发症。将术中估计失血量和术后并发症发生率与患者年龄、术前血小板计数、脾脏重量以及骨髓纤维化诊断作为回归协变量进行关联分析。脾切除术的指征为治疗性的患者有76例（92%）。脾脏重量中位数为760克，22例患者有巨脾。脾脏重量超过1500克的患者术中估计失血量中位数显著更高（300毫升；p = 0.02）。在多元线性回归分析中，脾脏重量是估计失血量的主要决定因素（p = 0.02）。22例患者（27%）出现术后并发症，其中5例死亡（6%）。骨髓纤维化患者并发症发生率最高（50%），术后死亡率也最高（21%；p = 0.04）。在逻辑回归模型中，估计失血量是与术后并发症显著相关的唯一变量（p = 0.02）。血液系统疾病行脾切除术即使主要指征为治疗性，术后早期并发症发生率也可接受。特别高危的患者包括术中失血量增加、有巨脾和骨髓纤维化的患者。
