Safran D, Bloom G P
Department of Surgery, Hartford Hospital, Connecticut 06115.
Am Surg. 1990 Oct;56(10):601-5.
Four cases of spontaneous splenic rupture after infectious mononucleosis (IM) have been treated at this institution since 1978. The condition is rare, occurring in 0.1-0.5 per cent of patients with proven infectious mononucleosis. Splenectomy is considered the treatment of choice for these patients. However, because recent trends in the management of traumatic splenic rupture are moving towards nonoperative treatment with selected patients, a similar approach has been considered for the patient with spontaneous splenic rupture following IM. The major reason for avoiding splenectomy is the increased incidence of sepsis in splenectomized patients. Yet, splenic rupture is accompanied by hemorrhage and the risks associated with blood transfusion for ongoing hemorrhage are of similar magnitude as those of sepsis following splenectomy. In addition, the grossly abnormal spleens seen at operation tend to include large, contained hematomas that may also be prone to rupture. Therefore, operative management still appears to be the preferred treatment for spontaneous splenic rupture following IM. Splenectomy is curative, safe, and obviates the need for transfusion, extended hospitalization, and activity restriction.
自1978年以来，该机构共治疗了4例传染性单核细胞增多症（IM）后自发性脾破裂的病例。这种情况很罕见，在确诊为传染性单核细胞增多症的患者中发生率为0.1%-0.5%。脾切除术被认为是这些患者的首选治疗方法。然而，由于创伤性脾破裂的治疗趋势正朝着对部分患者进行非手术治疗发展，对于IM后自发性脾破裂的患者也考虑采用类似的方法。避免进行脾切除术的主要原因是脾切除术后败血症的发生率增加。然而，脾破裂会伴有出血，持续出血时输血的风险与脾切除术后败血症的风险相当。此外，手术中所见的明显异常脾脏往往包括大的、局限性血肿，这些血肿也可能易于破裂。因此，手术治疗似乎仍然是IM后自发性脾破裂的首选治疗方法。脾切除术具有治愈性、安全性，且无需输血、延长住院时间和限制活动。
