Owusu-Ofori Shirley, Hirst Ceri
Transfusion Medicine Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Cochrane Database Syst Rev. 2013 May 31(5):CD003425. doi: 10.1002/14651858.CD003425.pub2.
Acute splenic sequestration crises are a complication of sickle cell disease, with high mortality rates and frequent recurrence in survivors of first attacks. Splenectomy and blood transfusion, with their consequences, are the mainstay of long-term management used in different parts of the world.
To assess whether splenectomy (total or partial), to prevent acute splenic sequestration crises in people with sickle cell disease, improved survival and decreased morbidity in people with sickle cell disease, as compared with regular blood transfusions.
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, which comprises of references identified from comprehensive electronic database searches and handsearching relevant journals and abstract books of conference proceedings.Additional trials were sought from the reference lists of the trials and reviews identified by the search strategy.Date of the most recent search: 06 December 2012.
All randomized or quasi-randomized controlled trials comparing splenectomy (total or partial) to prevent recurrence of acute splenic sequestration crises with no treatment or blood transfusions in people with sickle cell disease.
No trials of splenectomy for acute splenic sequestration were found.
No trials of splenectomy for acute splenic sequestration were found.
AUTHORS' CONCLUSIONS: Splenectomy, if full, will prevent further sequestration and if partial, may reduce the recurrence of acute splenic sequestration crises. However, there is a lack of evidence from trials showing that splenectomy improves survival and decreases morbidity in people with sickle cell disease. There is a need for a well-designed, adequately-powered, randomized controlled trial to assess the benefits and risks of splenectomy compared to transfusion programmes, as a means of improving survival and decreasing mortality from acute splenic sequestration in people with sickle cell disease.
急性脾滞留危象是镰状细胞病的一种并发症，死亡率高，首次发作幸存者常复发。脾切除术和输血及其后果是世界不同地区长期治疗的主要手段。
评估与常规输血相比，镰状细胞病患者行脾切除术（全脾或部分脾切除）以预防急性脾滞留危象是否能提高生存率并降低发病率。
我们检索了Cochrane囊性纤维化和遗传性疾病组血红蛋白病试验注册库，该注册库包括通过全面电子数据库检索、手工检索相关期刊以及会议论文摘要书籍确定的参考文献。通过检索策略确定的试验和综述的参考文献列表中寻找其他试验。最近一次检索日期：2012年12月6日。
所有比较脾切除术（全脾或部分脾切除）与不治疗或输血以预防镰状细胞病患者急性脾滞留危象复发的随机或半随机对照试验。
未找到脾切除术治疗急性脾滞留的试验。
未找到脾切除术治疗急性脾滞留的试验。
全脾切除术可预防进一步的脾滞留，部分脾切除术可能减少急性脾滞留危象的复发。然而，缺乏试验证据表明脾切除术能提高镰状细胞病患者的生存率并降低发病率。需要进行一项设计良好、样本量充足的随机对照试验，以评估脾切除术与输血方案相比的益处和风险，作为提高镰状细胞病患者生存率和降低急性脾滞留死亡率的一种手段。
