Gnassingbe Komla, Akakpo-Numado G Komlatsé, Attipou Komla, Gbadoe Adama, Tekou Hubert
Service de chirurgie pédiatrique, CHU-Tokoin de Lomé, BP 57, Lomé, Togo.
Sante. 2007 Oct-Dec;17(4):207-11. doi: 10.1684/san.2007.0082.
To assess the effects of splenectomy in children with sickle cell anemia and to propose a therapeutic approach to splenomegaly in sickle cell anemia.
This retrospective study, conducted in the pediatric surgery department of the Tokoin Teaching Hospital in Lomé, included 8 children followed for sickle cell anemia (hetero- and homozygous) and who were admitted from January 1987 through December 2004 for splenic rupture or referred for prophylactic splenectomy.
The patients' mean age at splenectomy was 9 years 6 months. Five were homozygous and three heterozygous; on Hackett's scale, spleen size was 4 for four patients and 5 for the other four. All had episodes of pain of the left hypochondrium before surgery and were averaging one blood transfusion a year. Five splenectomies were for traumatic rupture of splenomegaly and three for other splenic complications. Splenectomy made it possible to decrease the frequency of blood transfusions. Pre- and postoperative prophylaxis against infection included penicillin and vaccinations.
The review of literature shows a frequent loss of immune function in the enlarged spleens of children with sickle cell anemia. The authors propose prophylactic splenectomy in children with splenomegaly, to prevent the risk of splenic rupture and other complications. Preventive measures after the splenectomy are necessary to control infections.
评估脾切除术对镰状细胞贫血患儿的影响，并提出镰状细胞贫血脾肿大的治疗方法。
这项回顾性研究在洛美托科因教学医院儿科外科进行，纳入了8例镰状细胞贫血（杂合子和纯合子）患儿，他们于1987年1月至2004年12月因脾破裂入院或被转诊接受预防性脾切除术。
脾切除术时患者的平均年龄为9岁6个月。5例为纯合子，3例为杂合子；根据哈克特量表，4例患者脾脏大小为4级，另外4例为5级。所有患者术前均有左季肋部疼痛发作，平均每年输血1次。5例脾切除术是因脾肿大外伤性破裂，3例是因其他脾脏并发症。脾切除术使得输血频率降低。术前和术后的感染预防措施包括使用青霉素和接种疫苗。
文献回顾显示，镰状细胞贫血患儿肿大的脾脏免疫功能常有丧失。作者建议对脾肿大患儿进行预防性脾切除术，以预防脾破裂和其他并发症的风险。脾切除术后的预防措施对于控制感染是必要的。
