Yu Songfeng, Ren Yanling, Wen Xue, Ye Yufu, Cheng Longyu, Yu Jun, Zheng Shusen
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
NHC Key Laboratory of Combined Multi-organ Transplantation, China.
Heliyon. 2023 Apr 3;9(4):e15114. doi: 10.1016/j.heliyon.2023.e15114. eCollection 2023 Apr.
Hepatosplenic candidiasis is a rare but severe complication in immunocompromised patients undergoing chemotherapy. Antifungal agents are widely accepted as the first choices for therapy. However, resistance to or side-effect of antifungal agents may comxpromise its efficiency. Splenectomy has also been rarely performed as treatment for this disease.
We present two cases of splenectomy for treating hepatosplenic candidiasis after failure of the initial drug therapy. Literatures on splenectomy as treatment for hepatosplenic candidiasis were searched in Pubmed and summarized.
Two leukemia patients developed hepatosplenic candidiasis after received chemotherapy for their primary diseases. Various antifungal agents including amphotericin B were all demonstrated failure to cure fever and the abscesses due to resistance or intractable side-effect. Laparoscopic splenectomy were finally performed and resolved the candidiasis successfully. A total of 12 splenectomy cases for treating hepatosplenic candidiasis had been previously reported in literature. All the cases showed either resistance or unimproved to initial antifungal therapies. Splenectomy provided salvage therapeutic value in all cases.
Splenectomy has therapeutic effect and may change the traditional concept in most surgeons. The present study may expand an alternative strategy in clinical practice guideline for the management of hepatosplenic candidiasis.
肝脾念珠菌病是接受化疗的免疫功能低下患者中一种罕见但严重的并发症。抗真菌药物被广泛认为是首选治疗药物。然而，抗真菌药物的耐药性或副作用可能会影响其疗效。脾切除术也很少用于治疗这种疾病。
我们报告了两例在初始药物治疗失败后行脾切除术治疗肝脾念珠菌病的病例。在PubMed上检索并总结了关于脾切除术治疗肝脾念珠菌病的文献。
两名白血病患者在接受原发性疾病化疗后发生肝脾念珠菌病。包括两性霉素B在内的各种抗真菌药物均因耐药或难以耐受的副作用而未能治愈发热和脓肿。最终实施了腹腔镜脾切除术，成功治愈了念珠菌病。此前文献中总共报道了12例脾切除术治疗肝脾念珠菌病的病例。所有病例对初始抗真菌治疗均表现出耐药或病情无改善。脾切除术在所有病例中均具有挽救治疗价值。
脾切除术具有治疗效果，可能会改变大多数外科医生的传统观念。本研究可能会为肝脾念珠菌病的临床实践指南拓展一种替代策略。
