Posey D L, Marks C
Am J Surg. 1983 Mar;145(3):318-21. doi: 10.1016/0002-9610(83)90190-3.
Three hundred ninety-three splenectomies were performed within the Charity Hospital system during the decade from 1969 through 1979. This number included 56 operations in children under 16 years of age, which formed the basis of this report of the risk of infection in young splenectomized patients and provided guidelines for the role of splenectomy under emergency and elective conditions. Eight episodes of serious infection were documented in four patients. There was only one case of overwhelming postsplenectomy infection which resulted in death, for a mortality rate of 1.8 percent (1 of 56 children) for death due to overwhelming postsplenectomy sepsis. It is emphasized, however, that the development of serious postsplenectomy sepsis in our series resulted in a 25 percent mortality rate. The risk of postsplenectomy sepsis is much greater in those individuals who are immunologically compromised, such as those who undergo staging splenectomy for Hodgkin's disease. If splenectomy is indicated for a hematologic disorder, it is wise to defer operation for as long as possible, especially if the acute episodes are self-limiting or mild. Rather than the promiscuous use of polyvalent serum and antibiotic therapy after splenectomy in children, it is recommended that parents be advised to bring the child to the hospital anytime an illness or fever develops that might require an immediate loading dose of an appropriate antibiotic. The role of subtotal splenectomy or hemisplenectomy merits consideration in staging Hodgkin's disease. Preoperative study of certain immunologic parameters may provide guidelines as to the proportion of individuals who may be vulnerable to overwhelming sepsis after splenectomy.
1969年至1979年这十年间，慈善医院系统共进行了393例脾切除术。其中包括56例16岁以下儿童的手术，这些手术构成了本报告中关于年轻脾切除患者感染风险的基础，并为急诊和择期情况下脾切除术的作用提供了指导方针。有4名患者记录了8次严重感染发作。仅有1例暴发性脾切除术后感染导致死亡，因暴发性脾切除术后败血症死亡的死亡率为1.8%（56名儿童中的1名）。然而，需要强调的是，在我们的系列研究中，严重的脾切除术后败血症的发生导致了25%的死亡率。在免疫功能受损的个体中，如因霍奇金病接受分期脾切除术的患者，脾切除术后败血症的风险要高得多。如果因血液系统疾病需要进行脾切除术，明智的做法是尽可能推迟手术，尤其是在急性发作是自限性或轻度的情况下。建议不要在儿童脾切除术后不加区别地使用多价血清和抗生素治疗，而是建议告知家长，一旦孩子出现可能需要立即给予适当抗生素负荷剂量的疾病或发烧，应随时带孩子去医院。在霍奇金病分期中，次全脾切除术或半脾切除术的作用值得考虑。术前对某些免疫参数的研究可能为脾切除术后易发生暴发性败血症的个体比例提供指导。
