Cardoso Daniel Linhares, Cardoso Filho Florentino DE Araújo, Cardoso Amanda Linhares, Gonzaga Marcelo Lima, Grande Antônio José
- University of Fortaleza, Faculty of Medicine, Fortaleza, CE, Brazil.
- General Hospital of Fortaleza, General Surgery, Fortaleza, Ceará, Brazil.
Rev Col Bras Cir. 2018 Jul 10;45(3):e1850. doi: 10.1590/0100-6991e-20181850.
Trauma is a public health problem and the most common cause of death in people under the age of 45. In blunt abdominal trauma, the spleen is the most commonly injured organ. Splenectomy remains the most common treatment, especially in high-grade lesions, despite increased nonoperative treatment. Removal of the spleen leads to increased susceptibility to infections due to its role in the immune function. Postsplenectomy sepsis is an important complication and presents a high mortality rate. Patients undergoing splenectomy should be immunized for encapsulated germs, as these are the agents most commonly associated with such infections. Splenic autotransplantation is a simple procedure, which can be an alternative to reduce infection rates consequent to total splenectomy, and reduce costs related to hospitalizations. This review aims to provide evidence-based information on splenic autotransplantation and its impact on the prognosis of patients undergoing total splenectomy. We searched the Cochrane Library, Medline/PubMed, SciELO and Embase, from January 2017 to January 2018 and selected articles in English and Portuguese, dated from 1919 to 2017. We found that the adjusted risk of death in splenectomized patients is greater than that of the general population, and when total splenectomy is performed, splenic autotransplantation is the only method capable of preserving splenic function, avoiding infections, especially postsplenectomy sepsis. Health professionals should be familiar with the consequences of the method chosen to manage the patient suffering from splenic trauma.
创伤是一个公共卫生问题，也是45岁以下人群最常见的死因。在钝性腹部创伤中，脾脏是最常受伤的器官。脾切除术仍然是最常见的治疗方法，尤其是在高级别损伤中，尽管非手术治疗有所增加。由于脾脏在免疫功能中的作用，切除脾脏会导致感染易感性增加。脾切除术后败血症是一种重要的并发症，死亡率很高。接受脾切除术的患者应接种针对包膜菌的疫苗，因为这些是最常与此类感染相关的病原体。脾自体移植是一种简单的手术，它可以作为一种替代方法，以降低全脾切除术后的感染率，并降低与住院相关的费用。本综述旨在提供关于脾自体移植及其对接受全脾切除术患者预后影响的循证信息。我们检索了2017年1月至2018年1月的Cochrane图书馆、Medline/PubMed、SciELO和Embase，并选择了1919年至2017年期间的英文和葡萄牙文文章。我们发现，脾切除患者的校正死亡风险高于一般人群，当进行全脾切除术时，脾自体移植是唯一能够保留脾脏功能、避免感染，尤其是脾切除术后败血症的方法。卫生专业人员应熟悉所选治疗方法对脾创伤患者的影响。
