Coad J E, Matutes E, Catovsky D
Academic Department of Hematology and Cytogenetics, Royal Marsden Hospital, London, England, UK.
Leuk Lymphoma. 1993 Jul;10(4-5):245-64. doi: 10.3109/10428199309148547.
Between February, 1970 and September, 1991, we performed splenectomies on 70 patients with chronic lymphoproliferative disorders including primary leukemias: 19 B-cell chronic lymphocytic leukemia, 1 B-cell prolymphocytic leukemia, 22 hairy cell leukemias, 4 large granular lymphocytic leukemias, 1 T-cell prolymphocytic leukemia, and non-Hodgkin's lymphomas (NHL): 10 splenic lymphomas with villous lymphocytes, 4 follicular lymphomas, 5 mantle cell lymphomas, 3 lymphoplasmacytic and 1 large cell NHL. The primary indications for surgery in this series were therapy-resistant disease (40%) and therapeutic splenectomy (38%). Postsplenectomy, 70% of patients had a complete hematological response, 23% had a partial response, and 7% were nonresponsive. Median treatment-free survival correlated with the hematologic response postsplenectomy and the underlying diagnosis. Better treatment-free survivals were seen in patients with lesser degrees of anemia and thrombocytopenia. Overall, improvements were more pronounced in the B-cell than in the T-cell disorders. Indications for further therapy, postoperative morbidity and mortality, and survival times are discussed along with a review of the literature. These findings advocate a continuing role for splenectomy in symptomatic lymphoid malignancies running with splenomegaly and hypersplenism.
1970年2月至1991年9月期间，我们对70例慢性淋巴细胞增殖性疾病患者实施了脾切除术，这些疾病包括原发性白血病：19例B细胞慢性淋巴细胞白血病、1例B细胞幼淋巴细胞白血病、22例毛细胞白血病、4例大颗粒淋巴细胞白血病、1例T细胞幼淋巴细胞白血病，以及非霍奇金淋巴瘤（NHL）：10例伴有绒毛状淋巴细胞的脾淋巴瘤、4例滤泡性淋巴瘤、5例套细胞淋巴瘤、3例淋巴浆细胞淋巴瘤和1例大细胞NHL。本系列手术的主要指征为治疗抵抗性疾病（40%）和治疗性脾切除术（38%）。脾切除术后，70%的患者有完全血液学缓解，23%有部分缓解，7%无反应。无治疗生存期的中位数与脾切除术后的血液学反应及潜在诊断相关。贫血和血小板减少程度较轻的患者无治疗生存期更长。总体而言，B细胞疾病的改善比T细胞疾病更明显。本文结合文献回顾讨论了进一步治疗的指征、术后发病率和死亡率以及生存时间。这些发现支持脾切除术在伴有脾肿大和脾功能亢进的有症状淋巴恶性肿瘤中继续发挥作用。
