Farley D R, Zietlow S P, Bannon M P, Farnell M B
Department of Surgery, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1992 Sep;67(9):846-53. doi: 10.1016/s0025-6196(12)60822-2.
Spontaneous splenic rupture is an extremely rare but life-threatening complication of infectious mononucleosis in young adults. Although splenectomy remains effective treatment, reports of successful nonoperative management have challenged the time-honored approach of emergent laparotomy. On retrospective analysis of our institutional experience with 8,116 patients who had this disease during a 40-year period, we found 5 substantiated cases of atraumatic splenic rupture due to infectious mononucleosis. Four additional cases of suspected splenic rupture were noted. All nine patients were hospitalized and treated (seven underwent splenectomy and two were treated with supportive measures only), and they remain alive and well. In patients with infectious mononucleosis suspected of having rupture of the spleen, a rapid but thorough assessment and prompt implementation of appropriate management should minimize the associated morbidity and mortality. On the basis of review of the medical literature and careful scrutiny of our own experience, we advocate emergent splenectomy for spontaneous splenic rupture in patients with infectious mononucleosis.
自发性脾破裂是年轻成年人传染性单核细胞增多症极为罕见但危及生命的并发症。尽管脾切除术仍是有效的治疗方法，但非手术治疗成功的报道对传统的急诊剖腹手术方法提出了挑战。通过对我们机构40年间8116例患有这种疾病的患者的经验进行回顾性分析，我们发现了5例因传染性单核细胞增多症导致的无创伤性脾破裂确诊病例。另外还注意到4例疑似脾破裂病例。所有9例患者均住院治疗（7例行脾切除术，2例仅采取支持性措施治疗），他们目前仍存活且状况良好。对于疑似脾破裂的传染性单核细胞增多症患者，快速而全面的评估以及及时实施适当的治疗应可将相关的发病率和死亡率降至最低。基于对医学文献的回顾以及对我们自身经验的仔细审视，我们主张对传染性单核细胞增多症患者的自发性脾破裂进行急诊脾切除术。
