al-Salem A H, Qaisaruddin S, Nasserallah Z, al Dabbous I, al Jam'a A
Department of Surgery, Qatif Central Hospital, Saudi Arabia.
Am J Surg. 1996 Sep;172(3):254-8. doi: 10.1016/S0002-9610(96)00158-4.
Splenic complications of sickle-cell disease (SCD) are associated with morbidity, and in some it may lead to mortality. This paper presents our experience with 43 patients with SCD who had splenectomy as part of their management.
The records of 43 patients with SCD who had splenectomy were examined for age at operation, sex, hemoglobin (Hb) electrophoresis, indication for splenectomy, pre- and postoperative medications, operative procedures, and postoperative complications.
The indications for splenectomy were acute splenic sequestration crisis (ASSC) in 21 patients, hypersplenism in 15, and splenic abscess in 7. In 17 patients, the spleen was also found to be massively enlarged causing discomfort and intervening with everyday activity. For those with hypersplenism, there was a significant postoperative increase in total Hb (P < 0.0001), hematocrit (P < 0.0001), white blood cells (P < 0.0001), and platelet count (P < 0.0001).
With careful perioperative management and proper follow-up, splenectomy in patients with SCD is beneficial in reducing their transfusion requirements and its attendant risks, eliminating the discomfort from mechanical pressure of the enlarged spleen, avoiding the risks of ASSC, and managing splenic abscess.
镰状细胞病（SCD）的脾脏并发症与发病率相关，在某些情况下可能导致死亡。本文介绍了我们对43例接受脾切除术作为治疗一部分的SCD患者的经验。
检查43例行脾切除术的SCD患者的手术年龄、性别、血红蛋白（Hb）电泳、脾切除指征、术前和术后用药、手术操作及术后并发症。
脾切除的指征为21例急性脾滞留危象（ASSC）、15例脾功能亢进和7例脾脓肿。17例患者还发现脾脏肿大严重，引起不适并影响日常活动。对于脾功能亢进患者，术后总血红蛋白（P<0.0001）、血细胞比容（P<0.0001）、白细胞（P<0.0001）和血小板计数（P<0.0001）均显著增加。
通过精心的围手术期管理和适当的随访，SCD患者行脾切除术有利于减少输血需求及其伴随风险，消除肿大脾脏机械压迫带来的不适，避免ASSC风险，并处理脾脓肿。
