Steinherz P G, Exelby P R, Young J, Watson R C
Med Pediatr Oncol. 1984;12(1):28-32. doi: 10.1002/mpo.2950120108.
Splenectomy for massive splenomegaly in thrombocytopenic patients refractory to platelet transfusions carries increased surgical risks. Blocking of the splenic artery may reduce the size of the organ, prolong the survival of transfused platelets, and reduce the surgical complications. We describe four cases of extreme splenomegaly and thrombocytopenia where successful splenectomy was carried out after angiographic embolization of the splenic artery in children with juvenile chronic myelogenous leukemia. Significant improvement was observed in platelet counts and in the survival of platelets after transfusions in three of the patients. There was a concomitant decrease in transfusion requirements. Isoimmunization prevented prolonged platelet survival in the fourth case. We recommend earlier splenectomy in these patients to reduce transfusion requirements and delay the onset of poor platelet survival after transfusions.
对于血小板输注无效的血小板减少症患者，因巨脾而行脾切除术会增加手术风险。阻断脾动脉可能会减小脾脏大小，延长输注血小板的存活时间，并减少手术并发症。我们描述了4例患有青少年慢性粒细胞白血病的儿童，他们存在极度脾肿大和血小板减少的情况，在对脾动脉进行血管造影栓塞后成功实施了脾切除术。3例患者的血小板计数以及输注后血小板的存活时间均有显著改善。同时，输血需求也有所减少。在第4例中，同种免疫反应阻碍了血小板的长期存活。我们建议对这些患者尽早进行脾切除术，以减少输血需求，并延缓输注后血小板存活不佳情况的出现。
