Liu Yakun, Jin Shaobin, Xu Ruone, Ding Cailin, Pang Wenbo, Li Yang, Chen Yajun
Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
Department of Pediatric Surgery, Qilu Hospital of Shandong University, No. 107 West Wenhua Street, Jinan, Shandong, 250000, China.
Pediatr Res. 2023 Apr;93(5):1336-1341. doi: 10.1038/s41390-022-02229-y. Epub 2022 Aug 1.
The infectious burden in hereditary spherocytosis (HS) children before splenectomy has rarely been reported and the risk of severe postsplenectomy infection is controversial.
We conducted a retrospective study of pediatric patients with HS to evaluate the risk of infection presplenectomy and postsplenectomy. The primary outcome was any bacterial, Mycoplasma, or fungal infection that required hospitalization. The secondary outcomes were sepsis and septic shock. Appendectomized children were matched on age at surgery and enrolled as controls.
In all, 232 patients were included. Before splenectomy, the primary outcome was identified in 51 (22.0%) patients, and the secondary outcome was identified in 1 (0.4%) patient. After splenectomy, the primary and secondary outcomes were detected in 8 (4.1%) and 1 (0.5%) patients, respectively. The risk of infection was higher presplenectomy than postsplenectomy (OR, 6.6; 95% CI, 3.0-14.2). HS patients had a higher risk of infection than the controls before surgery (OR, 3.7; 95% CI, 2.3-5.9) but not after surgery (OR, 1.4; 95% CI, 0.6-3.6).
HS patients who require splenectomy later in life had a high incidence of hospitalization for infections. In contrast, postsplenectomy risk of hospitalization involving infection or severe infection was low.
Patients with hereditary spherocytosis who require splenectomy later in life have a high risk of hospital admission for infections, especially those with severe hereditary spherocytosis. With vaccines or postoperative antibiotics, splenectomy does not increase the risk of infection or severe infections. Splenectomy may reduce the risk of hospitalization for infections by alleviating the complications of hereditary spherocytosis. With vaccines, prophylaxis, or advanced antibiotics, the benefits of splenectomy in children with hereditary spherocytosis and a heavy disease burden may outweigh the risks.
脾切除术前遗传性球形红细胞增多症（HS）患儿的感染负担鲜有报道，且脾切除术后严重感染的风险存在争议。
我们对HS儿科患者进行了一项回顾性研究，以评估脾切除术前和术后的感染风险。主要结局是任何需要住院治疗的细菌、支原体或真菌感染。次要结局是脓毒症和感染性休克。对接受阑尾切除术的儿童按手术年龄进行匹配并纳入作为对照。
总共纳入了232例患者。脾切除术前，51例（22.0%）患者出现主要结局，1例（0.4%）患者出现次要结局。脾切除术后，分别有8例（4.1%）和1例（0.5%）患者出现主要和次要结局。脾切除术前的感染风险高于术后（比值比，6.6；95%置信区间，3.0 - 14.2）。HS患者在手术前的感染风险高于对照组（比值比，3.7；95%置信区间，2.3 - 5.9），但术后无差异（比值比，1.4；95%置信区间，0.6 - 3.6）。
后期需要进行脾切除术的HS患者因感染住院的发生率较高。相比之下，脾切除术后因感染或严重感染住院的风险较低。
后期需要进行脾切除术的遗传性球形红细胞增多症患者因感染入院的风险较高，尤其是那些患有严重遗传性球形红细胞增多症的患者。通过接种疫苗或术后使用抗生素，脾切除术不会增加感染或严重感染的风险。脾切除术可能通过减轻遗传性球形红细胞增多症的并发症来降低因感染住院的风险。通过接种疫苗、预防措施或先进的抗生素，脾切除术对于患有遗传性球形红细胞增多症且疾病负担较重的儿童可能利大于弊。
