Sterchi J M, Buss D H, Beyer F C
Am Surg. 1984 Jan;50(1):20-2.
Partial splenectomy has been proposed for staging Hodgkin's disease, but the risk of thereby missing limited splenic involvement is unknown. To assess that risk, we reviewed all spleens removed during staging laparotomies for Hodgkin's disease at our institution, assessing splenic weight, the characteristics of all nodules, and grossly visible subcapsular disease. Among 180 spleens, 65 had splenic disease. Fifty-three had six or more nodules; for 49 of those, other abdominal involvement had been present or the disease was so diffuse that staging by partial splenectomy would have been correct. The remaining 12 spleens (18%) contained five or fewer nodules. Eleven had no grossly visible subcapsular nodules, and five of the 11 were associated with no other abdominal involvement. In four of those five, the disease was localized to one area in such a way that it could have been missed by partial splenectomy. All positive spleens averaged 415 g; the four spleens with localized involvement averaged 287 g. Thus, in four of 65 patients, a few splenic nodules in a localized distribution not visible grossly were the only evidence of abdominal Hodgkin's disease, and if partial splenectomy had been done there would have been a 6.2 per cent risk of understaging their Hodgkin's disease.
有人提出采用部分脾切除术对霍奇金病进行分期，但由此遗漏脾脏局限性受累的风险尚不清楚。为评估这一风险，我们回顾了在本机构对霍奇金病进行分期剖腹术时切除的所有脾脏，评估脾脏重量、所有结节的特征以及肉眼可见的包膜下病变。在180个脾脏中，65个有脾脏病变。53个有6个或更多结节；其中49个，存在其他腹部受累情况或疾病非常弥漫，采用部分脾切除术进行分期是正确的。其余12个脾脏（18%）有5个或更少结节。11个没有肉眼可见的包膜下结节，其中11个中有5个与其他腹部受累情况无关。在这5个中的4个中，疾病局限于一个区域，以至于部分脾切除术可能会遗漏。所有阳性脾脏平均重415克；4个有局限性受累的脾脏平均重287克。因此，在65例患者中的4例中，肉眼不可见的局限性分布的少数脾结节是腹部霍奇金病的唯一证据，如果进行了部分脾切除术，对其霍奇金病分期错误的风险为6.2%。
