Partial splenectomy in Gaucher's disease

In 11 children with hypersplenism due to Gaucher's disease, partial splenectomy was planned with the aim to prevent the development of postsplenectomy sepsis and also to slow the advance of the disease in the rest of the reticuloendothelial system by permitting continuing accumulation of the beta-glucocerebroside in the remaining splenic tissue. In seven children, partial splenectomy was performed successfully, the weight of the splenic tissue removed ranging from 400 to 3,680 g. The postoperative course was uneventful and the average duration of hospitalization was 12 days. In subsequent follow-up, isotope scanning demonstrated continuing growth of the splenic remnant and there were no episodes of postsplenectomy sepsis nor evidence of increased accumulation of beta-glucocerebroside in the liver or bones. These children showed a marked improvement in the growth curve and dramatic improvement in the hematologic picture. Of the four remaining children, in two, partial splenectomy was followed by complete removal of the remaining spleen due to necrosis, whereas in two, total splenectomy was performed since the huge spleens were extensively infarcted. Our experience suggests that partial splenectomy is the treatment of choice in the management of young patients with hypersplenism due to Gaucher's disease.     

Long-term follow-up of partial splenectomy in Gaucher's disease.

Seven children with Gaucher's disease who underwent partial splenectomy were followed for 7 to 8 years. None of the children had systemic sepsis or symptoms related to liver enlargement. Bone crisis occurred in only two children who had experienced bone crisis prior to partial splenectomy. This contrasts with the development of bone crises in five of six children who underwent total splenectomy at a similar age and who had previously been free of bone symptoms. Partial splenectomy should be regarded as a temporary solution in the treatment of hypersplenism and the mechanical compression related to the huge spleen. In 71% of the patients, massive enlargement and a severe to moderate degree of pancytopenia occurred again after 3 to 8 years; total splenectomy was required in three patients.     

Subtotal splenectomy preserving the inferior splenic pole for the treatment of Hodgkin’s lymphoma

IntroductionSplenectomy is helpful in the management of selected patients with Hodgkin’s lymphoma (HL), but in some cases this procedure is accompanied by a greater morbidity and mortality mainly due to sepsis. This is the first published case of subtotal splenectomy preserving the inferior splenic pole without the maintenance of the splenic vascular pedicle.Presentation of caseA 53-year-old man with HL refractory to chemo and radiotherapy associated to a very large spleen was successfully treated with subtotal splenectomy, preserving the inferior splenic pole supplied only by the left gastroepiploic and inferior splenic pole vessels. After an eleven year uneventful postoperative follow-up, the dimensions and function of the spleen are still preserved, and the disease is under control with chemo- and radiotherapy.ConclusionSubtotal splenectomy is efficacious to preserve the splenic functions and to prevent adverse effects of a large spleen on the treatment of Hodgkin’s lymphoma confined to superior pole and producing significant abdominal symptoms and hematological effects.     

Traumatic splenic injury: splenectomy vs. repair

Splenectomy has been the standard treatment during this century for traumatic splenic injuries. Because of the association between asplenia and overwhelming sepsis, recent attempts have been made to repair injured spleens. Details of splenic anatomy and blood supply allow prediction of the usual type of splenic injury that can be repaired. By utilizing a topical hemostatic agent, capsular sutures, and arterial ligation, severely traumatized spleens have been repaired. Postoperative splenic scanning is available in assessing remaining splenic tissue. The present and future ramifications of reparative splenic surgery are presented.     

Partial splenectomy prevents splenic sequestration crises in sickle cell disease

Purpose

Acute splenic sequestrations (SSs) are potentially fatal complications in sickle cell disease (SCD). Total splenectomies in young patients may predispose them to a higher risk of overwhelming infections, whereas partial splenectomy may maintain immunocompetence. We present our series of partial splenectomies in patients with multiple SS episodes.

Methods

We retrospectively reviewed the records of 6 patients who underwent open partial splenectomies for SS. Data on their clinical courses were collected and analyzed.

Results

None of the 6 patients had SS postprocedure, down from 2.1 ± 1.0 (P = .003) sequestrations per year and 3.5 ± 1.4 (P = .002) total sequestrations per patient. The transfusion requirements were significantly reduced postoperatively (10.2 ± 5.6 vs 2.0 ± 3.1 per year; P = .002). There was no increase in the infection-related hospital admissions during the period of follow-up (1.5 ± 1.8 vs 0.8 ± 0.8 per year after partial splenectomy; P = .363). The upper pole was preserved in all cases with blood supply off the main splenic artery.

Conclusions

Partial splenectomy decreases the risk of SS in SCD and reduces the need for blood transfusions. Infection rates did not increase after the procedure during the follow-up period. Partial splenectomy should be considered for patients who experience multiple acute SS crises or have long-term transfusion requirements.     

Stapled partial splenectomy for splenic abscess in a child

This is the case report of a boy with a splenic abscess that was successfully treated by partial splenectomy using an automatic stapler. The abscess was caused by Serratia marcescens, a nosocomial pathogen.     

Autotransplantation of splenic tissue after splenectomy in splenic injury in children

Long-term results and indices of immune reactivity in 30 patients who had splenectomy performed in childhood for trauma of the spleen were studied. The organ-preserving approach for this pathology is substantiated. Autotransplantation of the spleen pulp into the pocket formed from the greater omentum was performed in 5 children during splenectomy for trauma of the organ. An original device was used for better preparing the autotransplant. The postoperative period was without complications. The laboratory, sonographic and scintigraphic examinations have shown high functional activity of the transplanted spleen tissue.     

脾外伤行脾部分切除术的体会

目的探讨脾外伤行脾部分切除术的可行性和注意事项。方法对1999年1月～2005年10月间收治的19例Ⅱ～Ⅲ级脾外伤病人施行脾部分切除术的临床资料进行回顾性分析。结果本组19例均获治愈,仅1例术后3d发生延迟性大出血,重新行脾切除术外,其余均获得保脾。术后免疫功能检查正常,保留下来的脾脏血运良好。结论在坚持“保证生命,再保留脾脏”原则的基础上,脾部分切除术治疗脾外伤疗效肯定,安全可行,值得推广。     

Hand-assisted laparoscopic splenectomy for a splenic hamartoma: two case reports

We present two patients, each with a hamartoma of the spleen. These cases were thought to be well indicated for a hand-assisted laparoscopic approach and subsequent treatment was successful. Focal lesions of the spleen should be removed intact to allow a complete histological examination and to avoid peritoneal dissemination in case of malignancy. In these patients, the hand-assisted laparoscopic approach makes it possible to remove an unmorcellated organ and has the advantages of the laparoscopic technique. It can be considered as one of the suitable methods of surgical treatment.     

Laparoscopic splenectomy for a giant splenic epidermoid cyst: Report of a case

(Received for publication on Aug. 3, 1998; accepted on May 27, 1999)     

体质量指数与脾长径对脾切除联合贲门周围血管离断术效果的影响

目的探讨腹腔镜脾切除联合贲门周围血管离断术对于不同体质量指数（BMI）和脾长径患者的可行性和安全性。 方法回顾性分析2014年3月至2017年6月海南省第三人民医院实施腹腔镜脾切除联合贲门周围血管离断微创手术的194例患者，将患者分为肥胖组（BMI>25 kg/m²）108例和非肥胖组（BMI≤25 kg/m²）86例。根据术前超声、CT和（或）MRI测量脾脏长径的结果将患者分为AC>20 cm组和AC≤20 cm组。结合脾AC线长度进行亚组分析，统计并比较各组患者的手术情况以及并发症发生情况。 结果（1）肥胖组患者的平均手术时间和中转开腹手术比例均显著高于非肥胖组，差异有统计学意义[（184.43±40.72）min vs（158.31±37.65）min，t=2.372，P<0.05；36.11% vs 13.95%，χ²=4.831，P<0.05]；脾AC线>20 cm的患者中，肥胖组的平均手术时间和中转开腹手术比例均显著高于非肥胖组，差异有统计学意义[（224.16±41.38）min vs（167.26±31.54）min，t=2.408，P<0.05；25.00% vs 9.30%，χ²=4.627，P<0.05]。肥胖组内脾AC>20 cm的患者明显比AC≤20 cm的患者手术时间更长[（224.16±41.38）min vs（151.23±43.17）min，t=2.453，P<0.05]，中转开腹手术比例更高（25.00% vs 11.12%，χ²=4.168，P<0.05）。（2）肥胖组患者并发症总发生率显著高于非肥胖组，差异有统计学意义（37.96% vs 11.63%，χ²=5.024，P=0.025）。脾AC>20 cm的患者中，肥胖组的并发症发生率显著高于非肥胖组（49.06% vs 17.50%，χ²=4.236，P=0.023）。肥胖组内脾AC>20 cm与AC≤20 cm的患者术后并发症总发生率比较，差异无统计学意义（49.06% vs 27.27%，χ²=3.857，P=0.053）。 结论BMI过高延长了脾脏切除联合贲门周围血管离断微创手术的操作时间，脾长径>20 cm时增加了中转开腹手术和并发症发生的可能性。严格掌握脾脏切除贲门周围血管断流术的手术适应证，选择合适的手术时机，能够有效降低术后并发症的发生率，提高患者的预后质量。     

Hospital factors associated with splenectomy for splenic injury: a national perspective

BACKGROUND: The management of patients with splenic injury has shifted from routine splenectomy to attempts at splenic salvage. Using the Healthcare Cost and Utilization Project's National Inpatient Sample (HCUP-NIS), we assessed the patterns of care for splenic trauma. We hypothesized that the processes of care in urban and rural hospitals would differ. METHODS: Generalized estimating equations were used to identify predictor variables associated with laparotomy and splenectomy from a national, population-based sample of inpatients (HCUP-NIS). Fourteen thousand nine hundred one patients with an International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis code of 865 were selected from the 1998 to 2000 HCUP-NIS data. Exclusion criteria included age greater than 80 years. Analyses were compared using all patients and excluding patients who died during the first 2 hospital days. RESULTS: Eight thousand five hundred fifty-three patients were treated in urban teaching hospitals. Forty percent underwent a laparotomy and 28% underwent a splenectomy at that time. Another 4,461 patients were cared for in urban nonteaching hospitals. Of these, 46% had a laparotomy and 35% underwent a splenectomy. The remaining 1,887 patients were seen in rural hospitals. Forty-six percent had a laparotomy and 36% had a splenectomy. Patients in urban teaching hospitals had lower risk-adjusted odds of splenectomy in multivariate models controlling for confounders including overall injury severity. Overall splenic salvage increased from 1998 to 2000, primarily because of increased salvage rates among urban teaching hospitals. CONCLUSION: The management of patients with splenic injury differs among urban teaching, urban nonteaching, and rural hospitals. Surgeons at urban teaching hospitals appear more willing to attempt splenic salvage by means of nonoperative management.     

Influence of splenectomy, partial splenectomy and splenic artery ligation on E. coli sepsis in rats

Male Sprague-Dawley rats were allocated to four groups--sham operation, partial splenectomy, splenic artery ligation or total splenectomy, and 4 weeks after the operation 3 x 10(8) colony-forming units of Escherichia coli were injected intraperitoneally. Among the splenectomized rats the mortality was significantly (p less than 0.02) increased compared with the controls, while both partial splenectomy and splenic artery ligation did not influence survival. Blood clearance and organ (liver, spleen and lungs) uptake of intravenously injected, radiolabelled, heat-killed E. coli were determined 1 hour after the intraperitoneal challenge. Splenectomy caused a significant decrease in blood clearance. Splenic uptake of radiolabelled E. coli was significantly reduced following partial splenectomy and splenic artery ligation. The splenic operations increased hepatic uptake expressed per gram tissue. Splenectomy thus resulted in reduced blood clearance and increased mortality in Gram-negative sepsis, while the reduced splenic uptake following partial splenectomy or splenic artery ligation did not influence blood clearance of E. coli or mortality.     

腹腔镜下脾部分切除术治疗脾脏良性病变7例

目的 探讨腹腔镜下脾部分切除术治疗脾脏良性病变的安全性和可行性。方法 回顾性分析2015年1月至2018年12月期间，金华市中心医院对7例术前诊断为脾脏良性病变的患者实施腹腔镜下脾部分切除术的临床资料。结果 7 例患者脾脏病灶直径为6～15 cm，平均直径9.1 cm；4例位于脾脏上极，3例位于脾脏下极。7例患者均完成腹腔镜脾部分切除术，无中转开腹及围手术期死亡。手术时间为100～205 min，平均（165±17）min。术中出血量为70～230 mL，平均（148±56）mL。术后拔除腹腔引流管时间2～5 d；术后住院时间5～7 d。术后无腹腔大出血、消化瘘、腹腔感染等并发症。结论 腹腔镜下脾部分切除术治疗脾脏良性病变是安全可行的。     

脾损伤自体脾组织移植的临床应用

目的：探讨自体脾组织移植在临床中的应用。方法：总结32例脾外伤行全脾切除自体脾组织移植手术，其中采用大网膜囊内移植18例，去粘膜游离空肠段内移植12例，腹直肌鞘内移植2例。结果：术后随访均显示脾功能满意，尤以去粘膜游离空肠段内移植效果最好。结论：自体脾组织移植可作为严重脾外伤、全脾切除术后保留脾功能的一个重要有效手段，移植脾的功能恢复与血供有密切的关系。     

A cause for conversion of laparoscopic splenectomy: splenic candidiasis

Laparoscopic splenectomy (LS) is now considered the procedure of choice for removal of the spleen in several hematologic and traumatic splenic conditions. Perisplenitis is still considered a relative contraindication. We report a rare case of isolated splenic candidiasis treated by laparoscopic splenectomy. The technical challenges of the laparoscopic approach in cases of perisplenitis are outlined. Because of dense adhesions to the diaphragm, the LS was converted to open splenectomy, and the procedure was completed through a small subcostal incision. This case report suggests the need for and effectiveness of splenectomy in patients whose fungal infection is suspected to be localized to the spleen. Laparoscopic removal of the spleen in these cases is very difficult to accomplish because of the risk for diaphragm injuries and the technical problems encountered.     

Total splenic vein thrombosis after laparoscopic splenectomy: a possible candidate for treatment

BACKGROUND: Portal or splenic vein thrombosis (PSVT) is a common disorder after laparoscopic splenectomy (LS). Splenomegaly is a well-known risk factor for PSVT. However, no treatment strategy for PSVT has been established. METHODS: Thirty-three consecutive patients who had undergone LS and postoperative imaging surveillance were examined. PSVT was classified according to the site of thrombosis. We evaluated patient background, operative factors, and clinical symptoms. RESULTS: Spleen weight of patients with PSVT (n = 17, median 218 g) was greater than that of patients without PSVT (n = 16, median 101 g). Seven patients developed thrombosis involving the entire splenic vein (total splenic vein thrombosis), and 4 of them had clinical symptoms (fever >38 degrees C and/or abdominal pain). The incidence of clinical symptoms was significantly more frequent in patients with than without total SVT. Operation time, blood loss, and spleen weight were also significantly greater in patients with total SVT. Multiple logistic regression analysis demonstrated spleen weight was the strongest predictor of PSVT and total SVT. CONCLUSION: Patients with total SVT have greater risk factors for PSVT and frequently have clinical symptoms. They are candidates for anticoagulation therapy.