Maillot Jean, Malfuson Jean-Valère, Lazure Thierry, Benoist Stéphane, Cremades Anne, Hornez Emmanuel, Besson Florent L, Noël Nicolas, Lambotte Olivier
Service de Médecine Interne et Immunologie Clinique, APHP, Hôpitaux Universitaires Paris Saclay, Hôpital Bicêtre, 94720 Le Kremlin-Bicêtre, France.
Service d'Hématologie Clinique, Hôpital d'Instruction des Armées Percy, 92140 Clamart, France.
J Clin Med. 2021 Apr 6;10(7):1519. doi: 10.3390/jcm10071519.
Splenectomy is indicated in cases of trauma to the spleen or hematological and immunological diseases (hereditary spherocytosis, autoimmune cytopenia). Less frequently, splenectomy is performed for diagnostic purposes to complement unsuccessful prior etiological investigations. The splenectomy remains a surgery at risk of complications and should be considered as a last-resort procedure to make the diagnosis and to be able to treat patients. We studied the medical files of 142 patients who underwent a splenectomy for any reason over a 10-year period and identified 20 diagnostic splenectomies. Diagnostic splenectomies were mainly performed to explore unexplained splenomegaly for 13 patients and fever of unknown origin for 10. The other patients had surgery for other causes (cytopenia, abdominal symptoms, suspicion of relapsing malignant hemopathies). Splenectomy contributed to the final diagnosis in 19 of 20 cases, corresponding mostly to lymphoid hemopathies (14/20). The most frequent disease was diffuse large B-cell lymphoma (8/20). Splenectomy did not reveal any infectious disease. The most relevant pre-operative procedures to aid the diagnosis were F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and immuno-hematological examinations. Diagnostic splenectomy is useful and necessary in certain difficult diagnostic situations. Highlights: Diagnostic splenectomy is still useful in 2020 to diagnose unexplained splenomegaly or fever of unknown origin. Lymphoma was the most common final diagnosis. FDG PET/CT was the most useful tool to aid in the diagnosis.
脾切除术适用于脾脏创伤或血液学及免疫学疾病（遗传性球形红细胞增多症、自身免疫性血细胞减少症）的病例。较少情况下，进行脾切除术是为了辅助先前病因调查未成功的诊断目的。脾切除术仍然是一种有并发症风险的手术，应被视为做出诊断并能够治疗患者的最后手段。我们研究了142例在10年期间因任何原因接受脾切除术的患者的病历，并确定了20例诊断性脾切除术。诊断性脾切除术主要用于13例患者不明原因脾肿大的探查以及10例不明原因发热的探查。其他患者因其他原因（血细胞减少、腹部症状、怀疑复发性恶性血液病）接受手术。20例中有19例脾切除术有助于最终诊断，大多对应于淋巴系统血液病（14/20）。最常见的疾病是弥漫性大B细胞淋巴瘤（8/20）。脾切除术未发现任何感染性疾病。有助于诊断的最相关术前检查是F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）和免疫血液学检查。诊断性脾切除术在某些困难的诊断情况下是有用且必要的。要点：2020年，诊断性脾切除术对于诊断不明原因的脾肿大或不明原因发热仍然有用。淋巴瘤是最常见的最终诊断。FDG PET/CT是辅助诊断最有用的工具。
