Worni Mathias, Schudel Hans H, Güller Ulrich
Viszerale Chirurgie und Medizin, Inselspital, Universität Bern und Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Ther Umsch. 2013 Mar;70(3):171-6. doi: 10.1024/0040-5930/a000386.
Elective splenectomy in adults is often performed after failure of conservative treatment in patients with hematologic, neoplastic, or autoimmune disorders. The indication to perform a splenectomy should be discussed in an interdisciplinary team and the surgeon should not make the decision on his own. Laparoscopic splenectomy is nowadays established as the gold-standard treatment due to low morbidity and mortality and - compared to open surgery - lower postoperative pain, less intraoperative blood loss and shorter hospital stay. Every patient with planned splenectomy must undergo vaccination against pneumococci and meningococci at least two weeks prior to the operation, which helps reducing the risk of the "overwhelming post-splenectomy infection" (OPSI). Beside re-vaccination against pneumococci and meningococci during follow-up, every patient should be informed about the increased risk of infection, receive a personal post-splenectomy pass and emergency antibiotics in case of infection.
成人择期脾切除术通常在血液系统、肿瘤或自身免疫性疾病患者保守治疗失败后进行。是否进行脾切除术的指征应在多学科团队中进行讨论，外科医生不应独自做出决定。如今，腹腔镜脾切除术已成为金标准治疗方法，因为其发病率和死亡率较低，与开放手术相比，术后疼痛较轻、术中失血较少且住院时间较短。每位计划进行脾切除术的患者必须在手术前至少两周接受肺炎球菌和脑膜炎球菌疫苗接种，这有助于降低“脾切除术后暴发性感染”（OPSI）的风险。除了在随访期间再次接种肺炎球菌和脑膜炎球菌疫苗外，还应告知每位患者感染风险增加的情况，为其发放个人脾切除术后通行证，并在发生感染时提供急救抗生素。
