Gunnlaugsson S, Johannesson G M, Magnusson J
Laeknabladid. 1998 Nov;84(11):833-7.
Splenectomy following trauma is well known and the consequences have been investigated thoroughly. Several splenic diseases are treated by simple splenectomy. Furthermore, it may be necessary to do a splenectomy in case of intraoperative splenic trauma. The aim of this study was to investigate the indications for splenectomy in these two groups of patients and to estimate the longterm results.
We analysed all medical files of patients without history of splenic trauma but who nevertheless underwent splenectomy. We noted clinical features, laboratory findings, complications of the operation, volume of bloodloss and longterm results regarding the primary diagnosis.
In 1985-1994, 93 patients had splenectomy at the former noted occasions. We found medical files for 89 patients. Of them, 36 had disease of the spleen or diseases associated with it (group A) but 53 had no splenic disease (group B). In group A, a great variety of diseases led to splenectomies, idiopathic thrombocytopenic purpura being in the first place (28%) and non Hodgkin's lymphoma in the second place (12%). In group B the most common operation was a gastrectomy due to gastric cancer (30%) but in second place was an operation of the pancreas in connection with pancreas cancer (13%). The most common clinical indications for splenectomy in group A were thrombocytopenia (34%) and abdominal pain because of an enlarged spleen (23%). Intraoperative trauma (49%) of the spleen was the most common indication in group B. Before the operation, 13 patients got glucocorticoid steroids, nine patients received blood transfusions, and six patients got immunoglobulins, all in group A. There was less bloodloss and therefore a lower need for tranfusions in group A. Longterm results in group A, regarding primary disease, were good in 24 patients (67%), tolerable in three (8%), poor in four (11%) but uncertain in five (14%). Perioperative or postopertive complications were minimal. Often the results of splenectomies are good in patients with splenic diseases and these operations are quite safe.
Longterm results are strongly connected with the underlying disease. With greater attention and care we suppose the incidence of splenectomies could be lowered in patients without splenic disease.
创伤后脾切除术广为人知，其后果也已得到充分研究。几种脾脏疾病通过单纯脾切除术进行治疗。此外，术中脾脏创伤时可能有必要进行脾切除术。本研究的目的是调查这两组患者脾切除术的适应证，并评估长期结果。
我们分析了所有无脾脏创伤史但接受了脾切除术患者的病历。我们记录了临床特征、实验室检查结果、手术并发症、失血量以及关于原发性诊断的长期结果。
1985年至1994年期间，有93例患者在上述情况下接受了脾切除术。我们找到了89例患者的病历。其中，36例患有脾脏疾病或与之相关的疾病（A组），但53例没有脾脏疾病（B组）。在A组中，多种疾病导致了脾切除术，特发性血小板减少性紫癜位居首位（28%），非霍奇金淋巴瘤位居第二（12%）。在B组中，最常见的手术是因胃癌进行的胃切除术（30%），但第二位是与胰腺癌相关的胰腺手术（13%）。A组脾切除术最常见的临床适应证是血小板减少（34%）和因脾脏肿大引起的腹痛（23%）。B组中脾脏的术中创伤（49%）是最常见的适应证。术前，13例患者使用了糖皮质激素，9例患者接受了输血，6例患者使用了免疫球蛋白，均在A组。A组失血量较少，因此输血需求较低。A组关于原发性疾病的长期结果，24例良好（67%），3例尚可（8%），4例较差（11%），5例不确定（14%）。围手术期或术后并发症极少。脾脏疾病患者脾切除术的结果通常良好，这些手术相当安全。
长期结果与基础疾病密切相关。我们认为，通过给予更多关注和护理，可以降低无脾脏疾病患者的脾切除率。
