Pediatric Surgery Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China.
Pediatr Surg Int. 2024 Oct 29;40(1):280. doi: 10.1007/s00383-024-05879-7.
To explore the comparative postoperative efficacy of partial splenectomy (PS) and total splenectomy (TS) in the treatment of children with hereditary spherocytosis (HS).
The relevant HS studies from databases were searched and screened, comparing the differences in hemoglobin concentration, reticulocyte percentage, bilirubin concentration before and after TS and PS surgery, and during the follow-up period, as well as the incidence of postoperative adverse events. Statistical analysis was performed using Review Manager 5.4.
A total of 5 studies were included in this meta-analysis, with a cumulative enrollment of 312 children, 130 in the PS group and 182 in the TS group. The meta-analysis results showed that both PS and TS groups had statistically significant differences in postoperative hematological outcomes compared to before surgery, with TS showing better improvement than PS. In the postoperative follow-up, the changes in hematological outcomes between PS and TS were statistically significant for hemoglobin concentration: within 1 year [MD = 1.85, 95%CI(1.09,2.60)], 1-2 years [MD = 1.74, 95%CI(0.25,3.24)], not statistically significant for 4-6 years [MD = 1.28, 95%CI(-1.75,4.32)]; for reticulocyte percentage: within 1 year [MD = 2.23, 95%CI(0.80,3.66)] was statistically significant, not statistically significant for 4-6 years [MD = 1.77, 95%CI(-2.04,5.59)]; for serum bilirubin concentration: within 1 year [MD = 1.55, 95%CI(0.91,2.18)] was statistically significant, not statistically significant for 1-2 years [MD = 1.77, 95%CI(-2.04,5.99)]. In the incidence of postoperative adverse events, the incidence of cholelithiasis [MD = 1.77, 95%CI(-2.04,5.99)] showed a statistically significant difference between PS and TS, while there were no statistically significant differences in other included events, such as postoperative infection rate, secondary surgery rate, thrombosis rate, postoperative hemorrhage rate, and transfusion therapy rate.
Splenectomy is a beneficial surgical strategy for children with moderate-to-severe HS, reducing; early hematological outcomes of TS are more robust than PS in the follow-up period, and there is no difference between the two in the later period; for postoperative adverse events, the incidence of cholelithiasis in children after PS is higher than after TS, and there is a risk of requiring a second surgery for total splenectomy due to hemolytic recurrences.
探讨脾部分切除术（PS）和全脾切除术（TS）治疗遗传性球形红细胞增多症（HS）的术后疗效比较。
检索数据库中与 HS 相关的研究，并进行筛选，比较 PS 和 TS 手术后及随访期间血红蛋白浓度、网织红细胞百分比、胆红素浓度的差异，以及术后不良事件的发生率。使用 Review Manager 5.4 进行统计分析。
本荟萃分析共纳入 5 项研究，累计纳入 312 例患儿，PS 组 130 例，TS 组 182 例。荟萃分析结果显示，PS 和 TS 两组术后血液学结果均较术前有统计学差异，TS 组优于 PS 组。在术后随访中，PS 和 TS 两组在血红蛋白浓度方面的血液学结果变化有统计学意义：1 年内[MD=1.85，95%CI（1.09，2.60）]、1-2 年[MD=1.74，95%CI（0.25，3.24）]，4-6 年无统计学意义[MD=1.28，95%CI（-1.75，4.32）]；网织红细胞百分比方面：1 年内[MD=2.23，95%CI（0.80，3.66）]有统计学意义，4-6 年无统计学意义[MD=1.77，95%CI（-2.04，5.59）]；血清胆红素浓度方面：1 年内[MD=1.55，95%CI（0.91，2.18）]有统计学意义，1-2 年无统计学意义[MD=1.77，95%CI（-2.04，5.99）]。在术后不良事件发生率方面，PS 和 TS 两组在胆石症发生率[MD=1.77，95%CI（-2.04，5.99）]方面有统计学差异，而其他包括术后感染率、二次手术率、血栓形成率、术后出血率和输血治疗率在内的其他事件发生率无统计学差异。
脾切除术是治疗中重度 HS 儿童的有益手术策略，可降低；TS 的早期血液学结果在随访期更为强劲，后期两者无差异；对于术后不良事件，PS 术后儿童胆石症的发生率高于 TS，且因溶血复发需要再次进行全脾切除术的风险较高。
