O'Sullivan S T, Reardon C M, O'Donnell J A, Kirwan W O, Brady M P
University Department of Surgery, Cork Regional Hospital, Ireland.
Ir J Med Sci. 1994 Aug;163(8):374-8. doi: 10.1007/BF02942831.
The increased risk of sepsis in patients following splenectomy has been well documented. Fear of overwhelming post-splenectomy sepsis (OPSI) has resulted in a generalized trend towards splenic salvage among surgeons. However, splenorrhaphy and attempts at splenic salvage may of themselves predispose to significant morbidity, sometimes more serious than increased susceptibility to infection associated with splenectomy. This study aims to assess the risk of splenectomy and subsequent asplenia. We reviewed 246 patients who underwent splenectomy over a 16 year period. Indications for splenectomy were considered under the following headings: haematological (N = 116), trauma (N = 69), visceral carcinoma (N = 28), incidental (N = 13) and miscellaneous (N = 20). There were 28 deaths in the series, primarily among those in the intra-abdominal carcinoma (13) and multiple trauma (13) groups. Two deaths were recorded among patients undergoing elective splenectomy for benign disease. Thrombo-embolic complications were recorded in nine patients; respiratory tract infection in 36 patients and intra-abdominal abscess in two patients. Two cases of post-splenectomy pneumococcal septicaemia were documented, neither of which was fatal. While not an entirely benign procedure, splenectomy can be performed relatively safely, especially when performed for benign disease in an adult population.
脾切除术后患者败血症风险增加已有充分记录。对外科医生而言，由于担心发生暴发性脾切除术后败血症（OPSI），普遍存在一种倾向于保留脾脏的趋势。然而，脾修补术及保留脾脏的尝试本身可能会导致严重的发病情况，有时比与脾切除相关的感染易感性增加更为严重。本研究旨在评估脾切除及随后无脾状态的风险。我们回顾了在16年期间接受脾切除术的246例患者。脾切除的适应证按以下类别考虑：血液系统疾病（N = 116）、创伤（N = 69）、内脏癌（N = 28）、偶然发现（N = 13）和其他（N = 20）。该系列中有28例死亡，主要发生在腹内癌（13例）和多发伤（13例）组。择期行脾切除术治疗良性疾病的患者中有2例死亡。记录到9例患者发生血栓栓塞并发症；36例患者发生呼吸道感染，2例患者发生腹腔内脓肿。记录到2例脾切除术后肺炎球菌败血症病例，均非致命性。虽然脾切除术并非完全无害的手术，但相对安全，尤其是在成年人群中用于治疗良性疾病时。
