Kalpatthi Ram, Kane Ian D, Shatat Ibrahim F, Rackoff Betsy, Disco Deborah, Jackson Sherron M
Division of Pediatric Hematology and Oncology, The Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA.
Pediatr Surg Int. 2010 May;26(5):495-500. doi: 10.1007/s00383-010-2587-4. Epub 2010 Mar 23.
Despite advances in immune prophylaxis, sepsis remains the most feared complication following splenectomy for acute splenic sequestration crisis (ASSC) in children with sickle cell anemia (SCA). We seek to investigate the true prevalence of sepsis and other complications of splenectomy in this patient population.
We reviewed the records of children with SCA (HbSS) who underwent splenectomy for ASSC between 1993 and 2008 at a single institution.
Fifty-eight patients (33 males) at a median age of 2 years at splenectomy were included with an average post-splenectomy follow-up of 6.4 years (range 6 months-14 years). Thirty-seven patients (64%) underwent laparoscopic splenectomy, and acute chest syndrome (ACS) was the most common post-operative complication (6.9%). There was no difference in the incidence of sepsis pre- and post-splenectomy. The occurrence of vaso-occlusive pain crises (VOC) and ACS was significantly higher after splenectomy. In addition, 14 patients (24%) developed stroke (n = 5) or an abnormal transcranial Doppler (TCD) (n = 9) after splenectomy.
Our data suggest that splenectomy can be safely performed in children with SCA given a low risk of sepsis. However, the increased incidence of VOC, ACS, and stroke or abnormal TCDs after splenectomy remains a concern.
尽管免疫预防取得了进展，但败血症仍然是镰状细胞贫血（SCA）患儿因急性脾滞留危机（ASSC）行脾切除术后最令人担忧的并发症。我们试图调查该患者群体中败血症及脾切除术后其他并发症的真实发生率。
我们回顾了1993年至2008年在单一机构因ASSC接受脾切除术的SCA（HbSS）患儿的记录。
纳入了58例患者（33例男性），脾切除时的中位年龄为2岁，脾切除术后平均随访6.4年（范围6个月至14年）。37例患者（64%）接受了腹腔镜脾切除术，急性胸综合征（ACS）是最常见的术后并发症（6.9%）。脾切除术前和术后败血症的发生率没有差异。脾切除术后血管闭塞性疼痛危机（VOC）和ACS的发生率显著更高。此外，14例患者（24%）在脾切除术后发生了中风（n = 5）或经颅多普勒异常（TCD）（n = 9）。
我们的数据表明，鉴于败血症风险较低，SCA患儿可以安全地进行脾切除术。然而，脾切除术后VOC、ACS以及中风或TCD异常的发生率增加仍然令人担忧。
