Roshdy Merna Raafat, Botros Mina, Mokhles Abanoub, Aldemerdash Mohamed A, Sabet Haneen, Fahim Bishoy, Hindawi Mahmoud Diaa
Faculty of Medicine, Sohag University, 82511 Sohag, Egypt; Medical Research Group of Egypt, Negida Academy, Arlington, MA, USA.
Faculty of Medicine, Sohag University, 82511 Sohag, Egypt; Medical Research Group of Egypt, Negida Academy, Arlington, MA, USA.
J Pediatr Surg. 2025 Feb;60(2):162058. doi: 10.1016/j.jpedsurg.2024.162058. Epub 2024 Nov 5.
Sickle cell disease (SCD) patients encounter various complications, such as acute splenic sequestration crisis and hypersplenism that may require splenectomy. This systematic review and meta-analysis aims to clarify differences between total splenectomy (TS) or partial splenectomy (PS) in terms of hematological and postoperative outcomes.
We identified studies involving SCD patients who underwent PS or TS, whether open or laparoscopic, and whose hematological and operative outcomes were evaluated, through searching PubMed, Web of Science, Scopus, Embase and Cochrane databases from inception until June 2024.
hemoglobin concentration and reticulocytes %.
operative blood transfusion need, length of hospital stay (LoS), postoperative infections, overwhelming postsplenectomy sepsis (OPSS), acute chest syndrome (ACS), thromboembolic events and mortality.
Eighteen studies were included; 17 cohort and one case series. Seven studies collected data from the same SICHA institutions, so a total of 756 SCD patients is included. According to the most recent study, no significant changes in hemoglobin (preoperative 10.5 ± 0.3 vs 9.6 ± 0.4 one year postoperative in 24 PS cases, and 9.7 ± 0.1 vs 9.7 ± 0.2 in 73 TS cases), however, both TS and PS significantly decreased reticulocyte by 2 % (0.8-3.2 %). Proportional analysis of short-term infection revealed a lower incidence in TS 2.71 % vs 8.64 % in PS, and similarly for ACS, it is 6.97 % in TS vs 14.90 % in PS.
This first systematic review and meta-analysis shows that TS and PS have no or minimal effect on hemoglobin but a strong lowering effect on reticulocyte %. Proportional analysis reveals lower short-term infections and ACS following TS than PS. However, further clinical trials are necessary to draw definite conclusions and improve surgical decision making.
Systematic review and meta-analysis of cohort studies.
II.
镰状细胞病（SCD）患者会遭遇各种并发症，如急性脾滞留危象和脾功能亢进，可能需要进行脾切除术。本系统评价和荟萃分析旨在阐明全脾切除术（TS）或部分脾切除术（PS）在血液学和术后结局方面的差异。
我们通过检索PubMed、Web of Science、Scopus、Embase和Cochrane数据库，从数据库建立至2024年6月，识别了涉及接受PS或TS的SCD患者的研究，无论手术方式是开放手术还是腹腔镜手术，且对其血液学和手术结局进行了评估。
血红蛋白浓度和网织红细胞百分比。
手术输血需求、住院时间（LoS）、术后感染、脾切除术后暴发性感染（OPSS）、急性胸综合征（ACS）、血栓栓塞事件和死亡率。
纳入18项研究；17项队列研究和1项病例系列研究。7项研究收集了来自同一SICHA机构的数据，因此共纳入756例SCD患者。根据最新研究，血红蛋白无显著变化（24例PS患者术前为10.5±0.3，术后1年为9.6±0.4；73例TS患者术前为9.7±0.1，术后为9.7±0.2），然而，TS和PS均使网织红细胞显著降低2%（0.8 - 3.2%）。短期感染的比例分析显示，TS的发生率较低，为2.71%，而PS为8.64%；同样，ACS方面，TS为6.97%，PS为14.90%。
这项首次系统评价和荟萃分析表明，TS和PS对血红蛋白无影响或影响极小，但对网织红细胞百分比有显著降低作用。比例分析显示，TS术后短期感染和ACS低于PS。然而，需要进一步的临床试验才能得出明确结论并改善手术决策。
队列研究的系统评价和荟萃分析。
II级。
