Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Kaplan St 14, 4920235, Petah Tikva, Israel.
Head of Hematology Unit, Schneider Children's Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
Eur J Pediatr. 2019 Sep;178(9):1363-1367. doi: 10.1007/s00431-019-03424-6. Epub 2019 Jul 16.
Emergency splenectomy is rarely performed since a widespread consensus exists towards conservative management of splenic injury. However, in selected conditions, mainly hematological, there is a role for emergency or urgent splenectomy. This study aims to retrospectively review these cases and discuss outcome in relation to the pre-existing splenic pathologies. Between 2000 and 2015, 12 patients, five girls, and seven boys, with a median age of six years (3 months-13.11 years), underwent emergency or urgent splenectomy for non-traumatic conditions. All patients had major associated disorders; mainly hematological (11 cases) including hemolytic anemia with pancytopenia (1), sickle cell anemia (1), AML (1), ALL (2), CML (1), T cell lymphoma (1), Burkitt lymphoma (1), and ITP (3). One patient had a microvillous inclusion disease. Indications for splenectomy included diffuse resistant splenic abscesses (4), intracranial hemorrhage (4) or hypersplenism (3) with refractory thrombocytopenia, and spontaneous splenic rapture (1). Nine patients improved following surgery but three died, owing to massive intracranial hemorrhage (1) and severe respiratory failure (2) despite aggressive management.Conclusions: Rarely, an emergency splenectomy is required in complex settings, mostly refractory hematological conditions, in a deteriorating patient when all other measurements have failed. A multidisciplinary team approach is mandatory in the treatment of these complex cases. What is known • Conservative treatment is advised for splenic injury. • Many hematological disorders are responsible of splenic pathology. What is new • Emergency splenectomy in children for reasons other than trauma is a treatment of last resort that should be performed in a multidisciplinary context. • The outcome of emergency splenectomy in children for reasons other than trauma depends on the underlying medical condition.
急诊脾切除术很少进行，因为对于脾损伤的处理存在广泛的保守治疗共识。然而，在某些特定情况下，主要是血液学方面，急诊或紧急脾切除术有其作用。本研究旨在回顾性分析这些病例，并讨论与先前存在的脾脏病变相关的结果。2000 年至 2015 年期间，12 名患者，5 名女孩和 7 名男孩，中位年龄为 6 岁（3 个月至 13.11 岁），因非创伤性疾病接受了急诊或紧急脾切除术。所有患者均存在主要的相关疾病；主要为血液学疾病（11 例），包括伴全血细胞减少的溶血性贫血（1 例）、镰状细胞贫血（1 例）、急性髓细胞白血病（1 例）、急性淋巴细胞白血病（2 例）、慢性髓细胞白血病（1 例）、T 细胞淋巴瘤（1 例）、伯基特淋巴瘤（1 例）和特发性血小板减少性紫癜（3 例）。1 例患者患有微绒毛包涵体病。脾切除术的指征包括弥漫性耐药性脾脓肿（4 例）、颅内出血（4 例）或脾功能亢进伴难治性血小板减少症（3 例）和自发性脾破裂（1 例）。9 例患者术后病情改善，但 3 例患者死亡，原因分别为严重颅内出血（1 例）和严重呼吸衰竭（2 例），尽管采取了积极的治疗措施。结论：在复杂的情况下，当所有其他治疗措施均无效且患者病情恶化时，很少需要进行急诊脾切除术，主要为治疗难治性血液学疾病。多学科团队的治疗方法对于这些复杂病例的治疗至关重要。已知情况 • 对于脾损伤，建议采用保守治疗。 • 许多血液学疾病可导致脾脏病变。新发现 • 对于非创伤性原因的儿童进行急诊脾切除术是一种最后的治疗手段，应在多学科背景下进行。 • 对于非创伤性原因的儿童进行急诊脾切除术的结果取决于潜在的医疗状况。
