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血液系统疾病的脾切除术

Splenectomy for haematological disorders.

作者信息

Jankulovski Nikola, Antovic Svetozar, Kuzmanovska Biljana, Mitevski Aleksandar

机构信息

University Clinic for Digestive Surgery, Skopje, R. Macedonia.

出版信息

Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2014;35(1):181-7.

Abstract

Splenectomy is therapeutic for a large host of conditions. It is a consequence of expanding the list of disorders and liberalizing the indications for splenectomy in many diseases. Red blood cells disorders: autoimmune hemolytic anemia, hereditary spherocytosis, hemoglobinopathies and thalassemia are prone to splenectomy after failure of medical therapy. A variety of thrombocytopenic disorders are improved by splenectomy, and the most common indication for splenectomy is ITP (idiopathic thrombocytopenic purpura). Splenectomy is successful in reversing hypersplenism in a spectrum of disease called myeloproliferative disorders. Relief of symptoms from splenomegaly is also achieved, but it does not affect the inexorable course of the disorder. The role of splenectomy in white blood cells disorders (leukemias and lymphomas) is only palliative and facilitates chemotherapy. Splenectomy in patients with hemathologic disorders imparts a risk of fulminant and life threatening infection "overwhelming postsplenectomy sepsis" that can be obviated by appropriate treatment. Although splenectomy for hemathologic disorders is only therapeutic and not curative, the relief of symptoms and for some disorders facilitation of chemotherapy leads to better quality of life and longer survival.

摘要

脾切除术对许多病症具有治疗作用。这是多种疾病中脾切除适应症放宽以及疾病种类增多的结果。红细胞疾病:自身免疫性溶血性贫血、遗传性球形红细胞增多症、血红蛋白病和地中海贫血在药物治疗失败后易于进行脾切除术。脾切除术可改善多种血小板减少性疾病,脾切除最常见的适应症是特发性血小板减少性紫癜(ITP)。脾切除术成功地逆转了一系列称为骨髓增殖性疾病的疾病中的脾功能亢进。脾肿大的症状也得到缓解,但这并不影响疾病不可阻挡的进程。脾切除术在白细胞疾病(白血病和淋巴瘤)中的作用仅是姑息性的,有助于化疗。血液系统疾病患者进行脾切除术会有暴发性和危及生命的感染风险,即“脾切除术后暴发性感染”,适当治疗可避免这种情况。虽然血液系统疾病的脾切除术只是治疗性而非治愈性的,但症状缓解以及对某些疾病化疗的促进作用可带来更好的生活质量和更长的生存期。

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