Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
Br J Surg. 2013 May;100(6):794-800. doi: 10.1002/bjs.9067. Epub 2013 Feb 21.
Splenectomy is performed for a variety of indications in haematological disorders. This study was undertaken to analyse outcomes, and morbidity and mortality rates associated with this procedure.
Patients undergoing splenectomy for the treatment or diagnosis of haematological disease were included. Indications for operation, preoperative risk, intraoperative variables and short-term outcomes were evaluated.
From January 1997 to December 2010, 381 patients underwent splenectomy for diagnosis or treatment of haematological disease. Some 288 operations were performed by an open approach, 83 laparoscopically, and there were ten conversions. Overall 136 patients (35·7 per cent) experienced complications. Postoperative morbidity was predicted by age more than 65 years (odds ratio (OR) 1·63, 95 per cent confidence interval 1·05 to 2·55), a Karnofsky performance status (KPS) score lower than 60 (OR 2·74, 1·35 to 5·57) and a haemoglobin level of 9 g/dl or less (OR 1·74, 1·09 to 2·77). Twenty-four patients (6·3 per cent) died within 30 days of surgery. Postoperative mortality was predicted by a KPS score lower than 60 (OR 16·20, 6·10 to 42·92) and a platelet count of 50,000/µl or less (OR 3·34, 1·25 to 8·86). The objective of the operation was achieved in 309 patients (81·1 per cent). The success rate varied for each indication: diagnosis (106 of 110 patients, 96·4 per cent), thrombocytopenia (76 of 115, 66·1 per cent), anaemia (10 of 16, 63 per cent), to allow further treatment (46 of 59, 78 per cent) and primary treatment (16 of 18, 89 per cent).
Splenectomy is an effective procedure in the diagnosis and treatment of haematological disease in selected patients.
脾切除术在各种血液系统疾病的治疗中均有应用。本研究旨在分析与该手术相关的结果、发病率和死亡率。
纳入因血液系统疾病的治疗或诊断而行脾切除术的患者。评估手术指征、术前风险、术中变量和短期预后。
1997 年 1 月至 2010 年 12 月，381 例患者因血液系统疾病的诊断或治疗而行脾切除术。288 例采用开放手术，83 例采用腹腔镜手术，10 例中转开腹。共有 136 例（35.7%）患者发生并发症。年龄>65 岁（比值比 1.63，95%置信区间 1.05 至 2.55）、卡氏功能状态评分（KPS）<60 分（比值比 2.74，1.35 至 5.57）和血红蛋白水平<9 g/dl（比值比 1.74，1.09 至 2.77）是术后发病率的预测因素。24 例（6.3%）患者术后 30 天内死亡。KPS<60 分（比值比 16.20，6.10 至 42.92）和血小板计数<50,000/μl（比值比 3.34，1.25 至 8.86）是术后死亡率的预测因素。309 例（81.1%）患者达到了手术目的。各适应证的手术成功率不同：诊断（110 例患者中的 106 例，96.4%）、血小板减少症（115 例患者中的 76 例，66.1%）、贫血（16 例患者中的 10 例，63.0%）、为进一步治疗（59 例患者中的 46 例，78.0%）和为初级治疗（18 例患者中的 16 例，89.0%）。
脾切除术在选择的患者中是一种有效的诊断和治疗血液系统疾病的方法。
