Tan Kenny, Lewis Gareth R, Chahal Rohit, Browning Anthony J, Sundaram Subramanian K, Weston Philip M T, Harrison Simon C W, Biyani Chandra Shekhar
The Mid Yorkshire Hospitals NHS Trust, Pinderfields General Hospital, Wakefield, UK.
Urol Int. 2011;87(1):59-63. doi: 10.1159/000326761. Epub 2011 Jun 22.
Iatrogenic injury to the spleen is not an uncommon complication. Left nephrectomy has been reported as the second commonest cause of iatrogenic splenectomy with a reported incidence between 1.3 and 24%. Iatrogenic splenectomy is associated with significant morbidity and mortality.
We reviewed the occurrence of iatrogenic splenectomy during left nephrectomy at our centre. Our aims were to determine the incidence of iatrogenic splenectomy within the Mid Yorkshire Hospitals NHS Trust in order to understand the nature of the splenic injury and the morbidity and mortality associated with it.
All splenectomy and nephrectomy histology reports from January 2000 to December 2007 were reviewed retrospectively. Indications for splenectomy and nephrectomy were identified. Patients' demographic data, tumour characteristics, operative details, length of hospital stay and any reported morbidity or mortality were collected.
A total of 447 nephrectomies were identified which included 234 left nephrectomies. Within the same period 136 cases of splenectomy were performed. Thirty-four cases were iatrogenic splenectomies and 12 were caused by left nephrectomy. The incidence was 5.13%. The male to female ratio was 1:1 with an average age of 66 years. Grade 2 and stage pT2 renal cancer were the commonest tumour characteristics. All iatrogenic injuries occurred during mobilisation of the colon or division of adhesion. The average operative time was 4.7 h. Average length of hospital stay was 14 days. Five patients had postoperative complications and 1 died of respiratory failure and sepsis.
Splenic injury during left nephrectomy is a morbid complication. A good understanding of anatomy and surgical approach may reduce the incidence, morbidity and mortality of iatrogenic splenectomy during left nephrectomy.
医源性脾损伤并非罕见的并发症。据报道，左肾切除术是医源性脾切除术的第二大常见原因，报告发病率在1.3%至24%之间。医源性脾切除术与显著的发病率和死亡率相关。
我们回顾了我院中心左肾切除术中医源性脾切除术的发生情况。我们的目的是确定米德约克郡医院国民保健服务信托基金中医源性脾切除术的发病率，以了解脾损伤的性质以及与之相关的发病率和死亡率。
回顾性分析2000年1月至2007年12月所有脾切除术和肾切除术的组织学报告。确定脾切除术和肾切除术的指征。收集患者的人口统计学数据、肿瘤特征、手术细节、住院时间以及任何报告的发病率或死亡率。
共确定447例肾切除术，其中包括234例左肾切除术。同期进行了136例脾切除术。34例为医源性脾切除术，12例由左肾切除术引起。发病率为5.13%。男女比例为1:1，平均年龄为66岁。2级和pT2期肾癌是最常见的肿瘤特征。所有医源性损伤均发生在结肠游离或粘连分离过程中。平均手术时间为4.7小时。平均住院时间为14天。5例患者有术后并发症，1例死于呼吸衰竭和败血症。
左肾切除术中的脾损伤是一种严重的并发症。对解剖结构和手术方法的充分了解可能会降低左肾切除术中医源性脾切除术的发病率、并发症和死亡率。
