Endo Yuichi, Ohta Masayuki, Shibata Kohei, Kai Seiichiro, Iwaki Kentaro, Uchida Hiroki, Ogata Masao, Ikewaki Junji, Kashima Kenji, Kitano Seigo
Department of Surgery I, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
Surg Today. 2008;38(12):1148-51. doi: 10.1007/s00595-008-3802-y. Epub 2008 Nov 28.
A 45-year-old woman with previously diagnosed chronic type adult T-cell leukemia (ATL) presented with abdominal discomfort and red eruptions on her arms and legs. Anemia, thrombocytopenia, hypercalcemia, and splenomegaly indicated progression to acute-type ATL. Combined chemotherapy resulted in normalization of the serum calcium level and improvement in her symptoms. However, the severe anemia and thrombocytopenia persisted, necessitating transfusions of red blood cells (RBC) and platelets three times a week. We performed splenectomy in an attempt to reduce the total volume of malignant cells and improve the hypersplenism. After the operation, the RBC and platelet counts increased gradually, and the transfusions were stopped on postoperative day (POD) 3. Splenectomy should be considered as an optional treatment for hypersplenism caused by ATL when hypersplenism cannot be controlled by chemotherapy in patients without a high surgical risk.
一名先前被诊断为慢性成年型T细胞白血病（ATL）的45岁女性，出现腹部不适以及手臂和腿部的红色皮疹。贫血、血小板减少、高钙血症和脾肿大表明病情已进展为急性型ATL。联合化疗使血清钙水平恢复正常，症状有所改善。然而，严重的贫血和血小板减少仍然存在，需要每周输注三次红细胞（RBC）和血小板。我们进行了脾切除术，试图减少恶性细胞的总量并改善脾功能亢进。术后，红细胞和血小板计数逐渐增加，术后第3天（POD 3）停止输血。对于手术风险不高且化疗无法控制脾功能亢进的ATL患者，脾切除术应被视为治疗ATL所致脾功能亢进的一种可选治疗方法。
