Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN 46202, USA.
Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 125, Indianapolis, IN 46202, USA.
J Pediatr Surg. 2021 Nov;56(11):1998-2004. doi: 10.1016/j.jpedsurg.2021.01.005. Epub 2021 Jan 8.
Partial, or subtotal, splenectomy (PS) has become an accepted alternative to total splenectomy (TS) for management of hematologic disorders in children, but little is known about its long-term outcomes. Here, we present our institutional experience with partial splenectomy, to determine rate of subsequent TS or cholecystectomy and identify if any factors affected this need.
All patients who underwent partial splenectomy at a single tertiary children's hospital were retrospectively reviewed from 2002 through 2019 after IRB approval. Primary outcome of interest was rate of reoperation to completion splenectomy (CS) and rate of cholecystectomy. Secondary outcome were positive predictor(s) for these subsequent procedures.
Twenty-four patients underwent PS, at median age 6.0 years, with preoperative spleen size of 12.7 cm by ultrasound. At median follow up time of 8.0 years, 29% of all patients and 24% of hereditary spherocytosis (HS) patients underwent completion splenectomy at median 34 months and 45 months, respectively. Amongst HS patients who did not have a cholecystectomy with or prior to PS, 39% underwent a delayed cholecystectomy following PS. There were no significant differences in age at index procedure, preoperative splenic volume, weight of splenic specimen removed, transfusion requirements, preoperative or postoperative hematologic parameters (including hemoglobin, hematocrit, total bilirubin, and reticulocyte count) amongst patients of all diagnoses and HS only who underwent PS alone compared to those who went on to CS. There were no cases of OPSS or deaths.
Partial splenectomy is a safe alternative to total splenectomy in children with hematologic disease with theoretical decreased susceptibility to OPSS. However, families should be counseled of a 29% chance of reoperation to completion splenectomy, and, in HS patients, a 39% chance of delayed cholecystectomy if not performed prior to or with PS. Further studies are needed to understand predictors of these outcomes.
部分脾切除术（PS）或次全脾切除术已成为儿童血液系统疾病治疗中全脾切除术（TS）的一种替代方法，但对其长期结果知之甚少。在此，我们报告了我们机构在部分脾切除术中的经验，以确定随后行全脾切除术或胆囊切除术的比率，并确定是否有任何因素影响这种需求。
在获得机构审查委员会批准后，回顾性分析了 2002 年至 2019 年期间在一家单中心三级儿童医院接受部分脾切除术的所有患者。主要观察指标为再次行全脾切除术（CS）的比率和胆囊切除术的比率。次要观察指标为这些后续手术的阳性预测因素。
24 例患者接受了 PS，中位年龄为 6.0 岁，术前超声检查脾脏大小为 12.7cm。中位随访时间为 8.0 年，所有患者中有 29%和遗传性球形红细胞增多症（HS）患者中有 24%分别在中位 34 个月和 45 个月时接受了 CS。在未接受 PS 时或之前接受胆囊切除术的 HS 患者中，有 39%的患者在 PS 后行延迟性胆囊切除术。所有诊断和仅 HS 的患者中，行 PS 组与行 CS 组相比，在指数手术时的年龄、术前脾脏体积、切除脾脏标本的重量、输血需求、术前或术后血液学参数（包括血红蛋白、血细胞比容、总胆红素和网织红细胞计数）方面无显著差异。所有患者均未发生 OPSS 或死亡。
部分脾切除术是儿童血液系统疾病治疗中 TS 的一种安全替代方法，理论上 OPSS 的发病率降低。然而，应告知患者家属，29%的患者有再次行 CS 的可能，如果不行 CS，则 39%的 HS 患者有行延迟性胆囊切除术的可能，且该手术应在 PS 前或 PS 时进行。需要进一步的研究来了解这些结果的预测因素。
