血液系统疾病的脾切除术：卡提夫中心医院的经验

Splenectomy for hematological diseases: The Qatif Central Hospital experience.

作者信息

Al-Salem A H, Naserullah Z, Qaisaruddin S, Al-Dabbous I, Al Abkari H, Al-Jam'a A, Al-Faraj A, Yassin Y M

机构信息

Division of Pediatric Surgery, Department of Surgery, and Department of Internal Medicine, Qatif Central Hospital, Qatif, Saudi Arabia.

出版信息

Ann Saudi Med. 1999 Jul-Aug;19(4):325-30. doi: 10.5144/0256-4947.1999.325.

DOI:10.5144/0256-4947.1999.325

PMID:17277533

Abstract

BACKGROUND

In the Eastern Province of Saudi Arabia, an area known for various hemoglobinopathies, splenectomy is performed rather frequently. This study is an analysis of our experience with splenectomy performed for various hematological disorders between 1988 and 1997, outlining the indications, complications and outcome.

PATIENTS AND METHODS

This is a retrospective analysis of all patients who had splenectomy at our hospital during this period. One hundred and forty-three patients were treated for various hematological disorders at our hospital. These disorders included sickle cell disease (SCD) (100 patients), sickle ss-thalassemia (S-ss-thal) (13 patients), ss-thalassemia major (15 patients), Hb H disease (3 patients), idiopathic thrombocytopenic purpura (ITP) (5 patients), Gaucherâs disease (2 patients), hereditary spherocytosis (1 patient), autoimmune hemolytic anemia (1 patient), thalassemia intermediate (2 patients) and chronic myeloid leukemia (1 patient).

RESULTS

The indications for splenectomy in those with SCD and S-ss-thal were: hypersplenism (26 patients), major splenic sequestration crisis (23 patients), minor recurrent splenic sequestration crisis (50 patients), splenic abscess (12 patients), and massive splenic infarction (2 patients). Splenectomy in these patients was beneficial in reducing their transfusion requirements and its attendant risks, eliminating the discomfort from mechanical pressure of the enlarged spleen, avoiding the risks of acute splenic sequestration crisis, and managing splenic abscess. For those with thalassemia, total splenectomy was beneficial in reducing their transfusion requirements, while partial splenectomy was beneficial only as a temporary measure, as regrowth of splenic remnant in these patients subsequently led to increase in their transfusion requirements. Those with ITP, hereditary spherocytosis, and autoimmune hemolytic anemia showed excellent response following splenectomy. There was no mortality, and the postoperative morbidity was 5.6%.

CONCLUSION

With careful perioperative management, splenectomy is both safe and beneficial in a selected group of patients with hematological diseases.

摘要

背景

在沙特阿拉伯东部省份，一个以各种血红蛋白病而闻名的地区，脾切除术相当频繁。本研究分析了我们在1988年至1997年间对各种血液系统疾病进行脾切除术的经验，概述了手术适应症、并发症及结果。

患者与方法

这是对在此期间我院所有接受脾切除术患者的回顾性分析。我院对143例患有各种血液系统疾病的患者进行了治疗。这些疾病包括镰状细胞病（SCD）（100例）、镰状β地中海贫血（S-ββ地中海贫血）（13例）、重型β地中海贫血（15例）、血红蛋白H病（3例）、特发性血小板减少性紫癜（ITP）（5例）、戈谢病（2例）、遗传性球形红细胞增多症（1例）、自身免疫性溶血性贫血（1例）、中间型地中海贫血（2例）和慢性髓性白血病（1例）。

结果

SCD和S-ββ地中海贫血患者脾切除术的适应症为：脾功能亢进（26例）、严重脾梗死危象（23例）、轻度复发性脾梗死危象（50例）、脾脓肿（12例）和大量脾梗死（2例）。对这些患者进行脾切除术有利于减少输血需求及其相关风险，消除肿大脾脏机械压迫带来的不适，避免急性脾梗死危象的风险，以及处理脾脓肿。对于地中海贫血患者，全脾切除术有利于减少输血需求，而部分脾切除术仅作为临时措施有益，因为这些患者脾脏残余组织的再生随后导致输血需求增加。ITP、遗传性球形红细胞增多症和自身免疫性溶血性贫血患者脾切除术后反应良好。无死亡病例，术后发病率为5.6%。