Division of General Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; Surgical Research Core, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
J Thorac Cardiovasc Surg. 2020 Sep;160(3):641-652.e2. doi: 10.1016/j.jtcvs.2019.07.133. Epub 2019 Sep 9.
The effect of incidental splenectomy during thoracoabdominal aortic aneurysm repair is unknown. We hypothesized incidental splenectomy was associated with decreased late survival.
We studied 1056 thoracoabdominal aortic aneurysm repairs from 2006 to 2016. Exclusion criteria were age less than 18 years (n = 9), prior splenectomy (n = 2), and intraoperative death (n = 3). This left 1042 thoracoabdominal aortic aneurysm repairs for analysis (median age, 65 years; interquartile range, 56-72), including 221 (21%) that were reoperations. Multivariable modeling identified predictors of operative mortality in the total cohort. Moreover, to adjust for baseline differences, propensity score matching was performed to examine the frequency of these outcomes in the total cohort (n = 132 pairs) and the early survivors (n = 110 pairs). Late survival was estimated by the Kaplan-Meier method, and risk of late mortality was assessed by Cox proportional hazards regression.
Incidental splenectomy was performed in 135 patients (13%), 36% of whom underwent reoperation. Operative mortality rates of the incidental splenectomy and nonincidental splenectomy groups were 16% versus 8% in both the overall study (P = .005) and the propensity score-matched (P = .07) cohorts. In multivariable analysis, incidental splenectomy independently predicted operative mortality (odds ratio, 2.2; 95% confidence interval, 1.21-3.94; P = .008). For early survivors, incidental splenectomy did not increase the risk of late mortality. Survival estimates of matched early survivors did not differ between the incidental splenectomy and nonincidental splenectomy groups (P = .29).
Incidental splenectomy during thoracoabdominal aortic aneurysm repair was associated with increased operative mortality but not reduced late survival. Splenic preservation is encouraged when feasible.
胸主动脉腹主动脉瘤修复术中意外脾切除术的效果尚不清楚。我们假设意外脾切除术与晚期存活率降低有关。
我们研究了 2006 年至 2016 年期间的 1056 例胸主动脉腹主动脉瘤修复手术。排除标准为年龄小于 18 岁（n=9）、既往脾切除术（n=2）和术中死亡（n=3）。因此，共分析了 1042 例胸主动脉腹主动脉瘤修复手术（中位年龄 65 岁；四分位间距 56-72），其中 221 例（21%）为再次手术。多变量模型确定了总队列中手术死亡率的预测因素。此外，为了调整基线差异，进行了倾向评分匹配，以检查总队列（n=132 对）和早期幸存者（n=110 对）中这些结果的发生频率。通过 Kaplan-Meier 法估计晚期生存率，并通过 Cox 比例风险回归评估晚期死亡率的风险。
在 135 例患者（13%）中进行了意外脾切除术，其中 36%的患者进行了再次手术。在整个研究（P=0.005）和倾向评分匹配（P=0.07）队列中，意外脾切除术组和非意外脾切除术组的手术死亡率分别为 16%和 8%。多变量分析表明，意外脾切除术独立预测手术死亡率（比值比，2.2；95%置信区间，1.21-3.94；P=0.008）。对于早期幸存者，意外脾切除术并未增加晚期死亡率的风险。在意外脾切除术和非意外脾切除术组之间，匹配后的早期幸存者的生存估计值没有差异（P=0.29）。
胸主动脉腹主动脉瘤修复术中意外脾切除术与手术死亡率增加有关，但与晚期生存率降低无关。在可行的情况下，鼓励保留脾脏。
