Witte C L, Corrigan J J, Witte M H, Van Wyck D B, O'Mara R E, Woolfenden J M
Surg Gynecol Obstet. 1980 Jan;150(1):75-80.
Ligation of the splenic artery was performed upon six children with a variety of peripheral cytopenias associated with hypersplenism to decrease splenic hyperfunction while preserving some splenic tissue. While this procedure initially improved the peripheral blood values in five patients--two patients with hereditary spherocytosis, one patient with idiopathic thrombocytopenic purpura, one patient with pyruvate-kinase hemolytic anemia and one patient with posthepatitic cirrhosis and splenomegaly--the hematologic derangement gradually recurred in four, necessitating eventual splenectomy in two. The sixth patient, an infant with histiocytosis-x, died soon after ligation of the splenic artery. Scintiscans of the spleen corroborated regrowth of the splenic remnant, principally the lower pole to which the vascular supply in the splenocolic ligament was not interrupted. Although ligation of the splenic artery is safe and promptly reduces splenic overreactivity, this operation can only be viewed as temporizing and not as definitive treatment of hypersplenism. On the other hand, in view of the protective function of the spleen against certain bacteria and protozoa, particularly in children with blood dyscrasia, the idea of achieving eusplenism or mild hyposplenism rather than asplenism by a graded reduction in the functional splenic mass through ischemic treatment of hypersplenism seems sound. Alternative methods of circulatory control, for instance, embolization of the splenic artery, of splenic function should be cautiously pursued.
对6名患有各种与脾功能亢进相关的外周血细胞减少症的儿童进行了脾动脉结扎术，以降低脾功能亢进，同时保留一些脾组织。虽然该手术最初改善了5名患者的外周血值——2名遗传性球形红细胞增多症患者、1名特发性血小板减少性紫癜患者、1名丙酮酸激酶溶血性贫血患者和1名肝炎后肝硬化脾肿大患者——但4名患者的血液学紊乱逐渐复发，最终2名患者需要进行脾切除术。第六名患者是一名患有组织细胞增多症X的婴儿，在脾动脉结扎术后不久死亡。脾脏闪烁扫描证实了脾残余的再生，主要是脾结肠韧带血管供应未中断的下极。虽然脾动脉结扎术是安全的，并且能迅速降低脾脏的过度反应，但该手术只能被视为一种临时措施而非脾功能亢进的确定性治疗方法。另一方面，鉴于脾脏对某些细菌和原生动物的保护功能，特别是在血液系统疾病患儿中，通过对脾功能亢进进行缺血治疗，逐步减少功能性脾组织量以实现脾功能正常或轻度脾功能减退而非无脾状态的想法似乎是合理的。对于循环控制的替代方法，例如脾动脉栓塞，应谨慎采用。
