Holdsworth R J, Irving A D, Cuschieri A
University Department of Surgery, Ninewells Hospital and Medical School, Dundee, UK.
Br J Surg. 1991 Sep;78(9):1031-8. doi: 10.1002/bjs.1800780904.
A collective critical review of the literature on postsplenectomy sepsis from 1952 to 1987 has been undertaken. The reports cover a cohort of 12,514 patients undergoing splenectomy but of these only 5902 reports were sufficiently detailed to allow a useful analysis. The incidence of infection after splenectomy in children under 16 years old was 4.4 per cent with a mortality rate of 2.2 per cent. The corresponding figures for adults were 0.9 per cent and 0.8 per cent respectively. The present analysis of well documented patients has shown that severe infection after splenectomy for benign disease is very uncommon except in infants (infection rate 15.7 per cent) and children below the age of 5 years (infection rate 10.4 per cent). Many of these reported postsplenectomy infections may have been coincidental. It is also apparent that children contract a different type of infection after splenectomy than adults, predominantly a meningitis which is less frequently fatal. Adults, in contrast, appear to develop a septicaemic type of illness associated with a higher mortality rate. This survey has also shown that children are reported to be more susceptible to pneumococcal sepsis than to infection caused by any other organism. Although the removal of the spleen in otherwise normal people does not appear to be associated with an increased frequency of infection, the presence of a coexistent disorder, notably hepatic disease, can increase the risk substantially.
我们对1952年至1987年间有关脾切除术后败血症的文献进行了全面的批判性综述。这些报告涵盖了12514例接受脾切除术的患者，但其中只有5902份报告足够详细，可供进行有效分析。16岁以下儿童脾切除术后的感染发生率为4.4%，死亡率为2.2%。成人的相应数字分别为0.9%和0.8%。目前对记录完善的患者的分析表明，除婴儿（感染率15.7%）和5岁以下儿童（感染率10.4%）外，良性疾病脾切除术后的严重感染非常罕见。许多报告的脾切除术后感染可能是巧合。同样明显的是，儿童脾切除术后感染的类型与成人不同，主要是脑膜炎，死亡率较低。相比之下，成人似乎会患上与较高死亡率相关的败血症类型疾病。这项调查还表明，据报道儿童比任何其他病原体引起的感染更容易患肺炎球菌败血症。虽然在其他方面正常的人切除脾脏似乎与感染频率增加无关，但并存疾病，尤其是肝脏疾病的存在，会大幅增加风险。
