Jaroch M T, Broughan T A, Hermann R E
Surgery. 1986 Oct;100(4):743-50.
Our experience at the Cleveland Clinic and that in the literature with splenic infarction were reviewed to describe the natural history of splenic infarction and provide guidelines for management. Data for this review included 75 patients identified by clinical studies or at autopsy during a 10-year period and a review of 77 cases reported in the literature. The cause of the infarct varied with age; patients under 40 years old most often had an associated hematologic disorder, while those older than 41 years old most often had an embolic event. Other etiologic factors included splenic vascular disease, anatomic abnormalities, collagen vascular disease, pancreatic disease, and nonhematologic malignancy. Left upper quadrant pain was the predominant symptom. Changes in the blood count included anemia (53%), leukocytosis (49%), and thrombocytosis (7%). Liver-spleen scans were diagnostic in 90% of patients and computerized tomography identified the infarct in 75%. Initial management consisted of hydration, analgesics, and frequent monitoring, with resolution of symptoms in 7 to 14 days. Splenectomy was performed for persistent symptoms or a complication of the infarct (splenic pseudocyst, abscess, or hemorrhage). An uncomplicated splenic infarction can be managed safely with medical treatment, but early surgical intervention (splenectomy) is necessary to lower the mortality rate of a complication of the infarct.
我们回顾了克利夫兰诊所的经验以及文献中关于脾梗死的内容，以描述脾梗死的自然病程并提供治疗指南。本次综述的数据包括在10年期间通过临床研究或尸检确定的75例患者，以及对文献中报道的77例病例的回顾。梗死原因随年龄而异；40岁以下的患者最常伴有血液系统疾病，而41岁以上的患者最常发生栓塞事件。其他病因包括脾血管疾病、解剖异常、胶原血管疾病、胰腺疾病和非血液系统恶性肿瘤。左上腹疼痛是主要症状。血常规变化包括贫血（53%）、白细胞增多（49%）和血小板增多（7%）。肝脾扫描对90%的患者具有诊断价值，计算机断层扫描能识别出75%的梗死灶。初始治疗包括补液、止痛和频繁监测，症状在7至14天内缓解。对于持续症状或梗死并发症（脾假性囊肿、脓肿或出血）则进行脾切除术。无并发症的脾梗死可通过药物治疗安全处理，但早期手术干预（脾切除术）对于降低梗死并发症的死亡率是必要的。
