Cabot E B, Brennan M F, Rosenthal D S, Wilson R E
Ann Surg. 1978 Jan;187(1):24-30. doi: 10.1097/00000658-197801000-00006.
A retrospective review of 19 patients with documented myeloid metaplasia undergoing, elective splenectomy during the past ten years at the Peter Bent Brigham Hospital is presented. The primary indications for splenectomy in 17 of these 19 were either hypersplenism or symptomatic splenomegaly. Eighteen of the 19 underwent both 59Fe-ferrokinetic studies and 51Cr-sequestration studies or, alternatively, 111In-marrow scintigraphy as a part of their routine preoperative evaluation. The death from sepsis of one patient six weeks post-operatively, whose marrow function was poor and whose level of splenic sequestration was minimal, confirms the efficacy of these studies in the preoperative prediction of hematologic response to splenectomy. Eighteen of the 19 patients benefited from the operation in terms of symptomatic relief and/or hematologic improvement, although surgery presumably did nothing to prolong survival in these patients. We conclude that splenectomy is indicated as a palliative maneuver for carefully selected patients with myeloid metaplasia without prohibitive operative risk, provided the criteria for selection of patients are adhered to and the surgeon and hematologist work together as a team.
本文回顾性分析了过去十年间在彼得·本特·布里格姆医院接受择期脾切除术的19例确诊为骨髓化生的患者。这19例患者中，17例脾切除的主要指征为脾功能亢进或有症状的脾肿大。19例患者中有18例在术前常规评估时进行了59Fe铁动力学研究和51Cr脾滞留研究，或者进行了111In骨髓闪烁显像。一名术后六周死于败血症的患者，其骨髓功能差且脾滞留水平极低，这证实了这些研究在术前预测脾切除术后血液学反应方面的有效性。19例患者中有18例在症状缓解和/或血液学改善方面从手术中获益，尽管手术可能对延长这些患者的生存期并无作用。我们得出结论，对于精心挑选的、手术风险并非过高的骨髓化生患者，脾切除术可作为一种姑息性手段，但前提是要坚持患者选择标准，并且外科医生和血液科医生要作为一个团队共同协作。
