Division of Pediatric Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, MS 39216, USA.
J Pediatr Surg. 2009 Nov;44(11):2088-91. doi: 10.1016/j.jpedsurg.2009.06.007.
Acute splenic sequestrations (SSs) are potentially fatal complications in sickle cell disease (SCD). Total splenectomies in young patients may predispose them to a higher risk of overwhelming infections, whereas partial splenectomy may maintain immunocompetence. We present our series of partial splenectomies in patients with multiple SS episodes.
We retrospectively reviewed the records of 6 patients who underwent open partial splenectomies for SS. Data on their clinical courses were collected and analyzed.
None of the 6 patients had SS postprocedure, down from 2.1 +/- 1.0 (P = .003) sequestrations per year and 3.5 +/- 1.4 (P = .002) total sequestrations per patient. The transfusion requirements were significantly reduced postoperatively (10.2 +/- 5.6 vs 2.0 +/- 3.1 per year; P = .002). There was no increase in the infection-related hospital admissions during the period of follow-up (1.5 +/- 1.8 vs 0.8 +/- 0.8 per year after partial splenectomy; P = .363). The upper pole was preserved in all cases with blood supply off the main splenic artery.
Partial splenectomy decreases the risk of SS in SCD and reduces the need for blood transfusions. Infection rates did not increase after the procedure during the follow-up period. Partial splenectomy should be considered for patients who experience multiple acute SS crises or have long-term transfusion requirements.
镰状细胞病（SCD）中急性脾隔离（SS）是一种潜在致命的并发症。对年轻患者进行全脾切除术可能会使他们面临更高的感染风险，而部分脾切除术可能会保持免疫功能。我们报告了我们在多次发生 SS 发作的患者中进行部分脾切除术的系列病例。
我们回顾性分析了 6 例行开放性部分脾切除术治疗 SS 的患者的病历。收集并分析了他们的临床病程数据。
6 例患者术后均未发生 SS，从每年 2.1±1.0 次（P=.003）和每位患者每年 3.5±1.4 次（P=.002）减少。术后输血需求明显减少（每年 10.2±5.6 次 vs 2.0±3.1 次；P=.002）。在随访期间，感染相关的住院次数没有增加（部分脾切除术后每年 1.5±1.8 次 vs 0.8±0.8 次；P=.363）。所有病例均保留了主脾动脉供应以外的脾脏上极。
部分脾切除术可降低 SCD 患者发生 SS 的风险，减少输血需求。在随访期间，手术后感染率没有增加。对于多次发生急性 SS 危象或长期需要输血的患者，应考虑行部分脾切除术。
