Holschneider A M, Belohradsky B H, Kricz-Klimek H, Strasser W
Klin Padiatr. 1983 Nov-Dec;195(6):394-8. doi: 10.1055/s-2008-1034406.
161 splenectomies are presented with a morbidity of 14.8% and a total mortality rate of 4.3%. The lethality rate due to severe infections (-3.9%), however, was high and mostly caused by an overwhelming postsplenectomy sepsis, pneumonia or meningitis. 61.5% of the infections were caused by pneumococcus. To drop that high lethality rate after splenectomy we replanted splenic tissue in seven patients. Scintigraphic investigations showed in all cases well vascularised splenic tissue. The immunoglobulins were in a normal range. Howell-Jolly bodies, however, did not disappear in all the patients. From our study as well as from the literature one has to conclude that replanted splenic tissue requires immunologic activity but a reduced capacity for phagocytosis. Therefore, in cases of traumatic injury to the spleen it is necessary to try to preserve as much of the organ as possible either by infrared coagulation, gluing with human fibrinogen or partial splenectomy. If these procedures are impossible a replantation of--50% of the original splenic tissue should be done and several thin homogenised particles replanted intra- or retroperitoneally. Out of that a preoperative vaccination against pneumococcal infection is necessary as well as a postoperative penicillin prophylaxis for about three years.
本文报告了161例脾切除术，其发病率为14.8%，总死亡率为4.3%。然而，严重感染导致的致死率（-3.9%）很高，主要是由脾切除术后暴发性败血症、肺炎或脑膜炎引起的。61.5%的感染是由肺炎球菌引起的。为了降低脾切除术后的高致死率，我们对7例患者进行了脾组织移植。闪烁扫描检查显示，所有病例的脾组织血管化良好。免疫球蛋白在正常范围内。然而，豪-乔小体并非在所有患者中都消失。从我们的研究以及文献中可以得出结论，移植的脾组织需要免疫活性，但吞噬能力降低。因此，在脾脏受到创伤性损伤的情况下，有必要尝试通过红外线凝固、用人纤维蛋白原粘合或部分脾切除术尽可能多地保留脾脏器官。如果这些操作无法进行，则应移植约50%的原脾组织，并将几个细小的匀浆颗粒移植到腹腔内或腹膜后。此外，术前需要接种肺炎球菌感染疫苗，术后需要进行约三年的青霉素预防。
