脾切除治疗血液病的现状

本文阐述了现代脾切除术治疗各种血液病的适应证和疗效，并就围手术期处理和手术并发症的防治作了讨论。     

基层医院血液病脾切除的体会

目的 探讨基层医院开展血液病选择性脾切除的可行性。方法 回顾性分析1985年以来我们开展的7例血液病脾切除临床资料，结合文献进行讨论。结果 7例血液病脾切除均获得满意疗效，随访3～18年(平均7年)，除1例术后5年死于车祸，余均健在，无复发和手术并发症。结论 严格掌握手术指征，认真做好围手术期处理，血液病选择性脾切除在基层医院是切实可行的。     

脾切除治疗68例良性血液病的效果观察

目的探讨脾切除对内科治疗无效的几种良性血液病的治疗效果。方法对68例良性血液病脾切除术病人的临床资料进行回顾性分析。结果无围手术期死亡病例,术中均无大出血,根据血液学参数结果,脾切除对遗传性球形红细胞增多症、原发性血小板减少性紫癜、β型地中海贫血、α型地中篎堆⒆陨砻庖咝匀苎云堆腥非械闹瘟菩Ч?有效率分别为100%、91.3%、90.0%、72.7%及66.7%。结论脾切除术对上述良性血液病行之有效。     

脾切除430例临床分析

目的 分析总结脾切除手术的近期疗效以提高其安全性、降低死亡率,减少并发症并指导正确掌握切脾适应证。方法 统计４３０例脾切除手术病人的临床资料,包括切脾指征、手术种类、术后并发症和手术死亡率。结果 切脾指征中原发疾病以肝脏为最多,占１９２例（４４．６５％）,尤其是门脉高压性脾亢１６４例（３８．１５％）;４３０例病人共行７６８例次不同类型的手术,除切脾外,以分流断流为最多,共７５例次（２３．６６％）;     

脾切除治疗血液病64例分析

目的探讨脾切除对血液病的治疗效果、适应证以及术后并发症。方法回顾分析1996年1至2008年1月哈尔滨医科大学附属第一临床医学院外科治疗64例血液病病人的临床资料,探讨脾切除对血液病的治疗效果、术后并发症及预防措施。结果脾切除对原发性血小板减少性紫癜、遗传性球形红细胞增多症、自身性免疫性溶血性贫血、真性红细胞增多症的治疗效果确切,有效率分别为84%、100%、60%和50%;对非霍奇金病、骨髓纤维化、慢性粒细胞白血病治疗效果欠佳。结论脾切除对内科治疗无效的良性血液病行之有效,对恶性血液系统疾病需慎重选择。     

血液病脾切除的经验体会

血液病与脾外科之间的关系甚为密切，自１８８７年Ｓｐｅｎｃｅｒ首次为遗传性球形细胞增多症（ｈｅｒｅｄｉｔａｒｙｓｐｈｅｒｏｃｙｔｏｓｉｓ，ＨＳ）作脾切除以来，血液病的脾切除治疗范围逐渐扩大，亦越来越受到医学界的重视。我们数十年来对１６种血液病约５００例病人进行了脾切除术，就其有关问题提出来与同道研究和商榷。１　手术指征的选择　　手术指征的选择尤为重要，因其与手术的成败有直接关系。对此，我们掌握的较为慎重和严格。１－１　溶血性贫血（ｈｅｍｏｌｙｔｉｃａｎｅｍｉａ，ＨＡ）１－１－１　ＨＳ引起红细胞的…     

脾部分切除治疗脾良性肿瘤(附16例报告)

目的:探讨脾部分切除术治疗脾良性肿瘤的疗效.方法:对16例脾良性肿瘤施行脾部分切除手术.其中6例采用脾部分切除加大网膜包裹残面术,10例采用脾部分切除加止血凝胶覆盖.对术后并发症进行统计.结果:16例中1例术后出现左膈下脓肿,1例脾部分坏死,余无并发症发生.平均住院时间12d.结论:脾部分切除术治疗脾良性肿瘤术后并发症少,住院时间短,是安全有效的手术.     

181例血液病脾切除术的麻醉处理

我院自1958～1988年9月,共收治各类血液病脾切除术181例,麻醉处理体会如下。临床资料(一)本组男92例,女89例,年龄最小1.7岁,最大64岁,其中14岁以下71例(占39.2%)。计血小极减少性紫癜(ITP)83例、再障贫血36例、地中海贫血综合征34例、遗传性球形红细胞增多症等其它贫血患者25例和各类白血病3例。术前伴有不同程度出血倾向者62例,伴有心肺功能不全及心电图异常者46例。(二)术前化验检查有血红蛋白记载的176例中,<100g/L(10g%)118例(67.0%),其中<50g%/L22例(12.5%),最低19g/L;白细胞计数180例中<5×10~9/L(5000/mm~2)88例(48.8%);血小板计数171例中<50×10~9/L(5万/mm~3)113例(64.8%),其中<10×10~9/     

脾脏相关血液系统疾病的外科治疗

目的 探讨脾切除术(包括腹腔镜脾切除术)治疗某些血液病的手术指征、治疗效果及并发症的防治.方法 对27例因血液系统疾病行脾切除的病历资料进行回顾性分析.结果 遗传性球形红细胞增多症(HS,4例):有效率100%;特发性血小板减少性紫癜(ITP,17例):显效率 76.47%(13/17)非霍奇金淋巴瘤(NHL,6例):切除脾脏有益于其综合治疗.术后并发症的发生率为7.41%(2/27).结论 脾切除治疗HS疗效肯定,是HS首选的治疗方法.脾切除治疗大多数ITP有效,应选择好适应证.ITP病人对皮质激素治疗的反应并不一定影响脾切除的疗效.对于恶性淋巴瘤,脾切除可作为其综合治疗措施中的主要手段.选择好手术适应证,做好围手术期处理,有益于减少并发症的发生.     

进展期近端胃癌根治术联合脾脏切除术适应证的选择

目的探讨进展期近端胃癌根治术联合脾脏切除术的合理适应证。方法选取我院自2005年3月至2008年2月期间50例进展期近端胃癌行全胃切除患者为研究对象,根据脾脏是否切除分为切脾组(n=18)和保脾组(n=32),比较2组患者间手术时间、住院时间、术后并发症以及脾门淋巴结转移情况。结果切脾组手术时间、住院时间和膈下感染发生率均明显高于保脾组(P0.05)。切脾组与保脾组术后病理检查出的第10、11组淋巴结转移率的差异无统计学意义(P0.05)。结论进展期近端胃癌根治术时,脾脏和脾血管受侵是联合脾脏切除的合理适应证。     

特发性血小板减少性紫癜脾切除术后早期并发症

目的 评估脾切除治疗特发性血小板减少性紫癜（ＩＴＰ）的安全性。方法 回顾分析了１６７例ＩＴＰ选择性脾切除术的术后早期并发症。结果 １４例（８．３８％）病人出现１７例次术后早期并发症;切口感染７例,腹腔大出血２例,颅内出血２例,膈下脓肿１例,肺感染１例,应激性高血糖反应４例。２例（１．２０％）术后并发颅内出血死亡。结论 选择性脾切除术是ＩＴＰ一种安全的治疗手段。     

腹腔镜脾切除术的研究进展

目的探讨腹腔镜脾切除术(laparoscopic splenectomy,LS)的手术方法、安全性及临床效果。方法对当前国内、外有关腹腔镜脾切除的研究报道及最新进展进行综述和分析。结果随着技术的进步,LS的适应证逐渐扩大;脾脏大小是影响LS手术效果的重要因素。结论LS具有微创外科的一切优点。对于巨大脾脏,选择手助的LS是安全可行的,且比开腹手术具有优越性。随着手术者经验的积累及手术方法、操作器械的不断改进,LS将越来越广泛地被应用于临床。     

Diagnostic Splenectomy for Visceral Leishmaniasis

A 57-year-old-man with a history of malaise, fever,night sweats and shortness of breath presented a diagnostic challenge to his medical team. He was pancytopaenic and had splenomegaly on admission but other investigations, including bone marrow aspiration, proved inconclusive. After the patient deteriorated clinically, the general surgical team was requested to perform a diagnostic splenectomy. The histology of this showed infection with visceral leishmaniasis. He recovered completely with Amphotericin treatment. Although this is a rare condition, particularly for the general surgeon, this case highlights the difficult position surgeons are often put in when performing major surgery diagnostically.     

Splenectomy in the treatment of hematologic diseases

After first splenectomy performed 1888 for spherocytosis until now, a number of hematological indications for therapeutical splenectomy were described, with established preoperative treatment and more favorable postoperative results in recent studies. In the period between 1985 and 1997, 130 splenectomies for hematological disorders were performed on Department of surgical gastroenterology, 1st Surgical Clinic. The indications were as follows: 72 patients with autoimmune hematological diseases (55.38%), 28 patients with lymphoproliferative diseases (21.54%), Hodgkin-s disease in 11 patients (8.46%), myeloproliferative diseases in 6 (4.62%), splenectomy as a part of staging laparotomy in patients (7.69%), and for other hematological disorders in 3 patients (2.31%). Most of the removed spleens (95) weighted from 500 to 1500 g (73.08%). In 19 patients spleens weighted less then 500 g (14.62%), and in 16 patients more then 1500 g (12.31%). There was no significant correlation between the weight of the removed spleen and the incidence of postoperative complications. In 8 patients with preoperative thrombocytopenia (6.16%), intraoperative infusions of fresh thrombocytes were used. In 12 patients (9.23%) postoperative complications occurred, mainly in the patients who received immunosuppressive therapy preoperatively in excessive amounts, and were disease-dependent. Overall mortality was 4 (3.12%), and in 2 patients there was "exitus in tabular". Delayed results depended of basic hematological disorder and supportive treatment. The surgical particularities of the operative procedure are discussed, as well as the perioperative treatment and certain aspects of teamwork of hematologist and surgeon.     

手助腹腔镜与开腹巨脾切除术的临床对比研究

目的对比手助腹腔镜与开腹手术治疗巨脾症的临床疗效。方法 2006年8月～2011年6月,将40例巨脾按患者意愿分成2组各20例,分别进行手助腹腔镜脾切除术(hand-assisted laparoscopic splenectomy,HALS)和传统开腹脾切除术(open splenectomy,OS),比较两组的手术时间、术中出血量、术后肛门排气时间、术后并发症发生率及术后住院时间等。结果 20例HALS组手术均获得成功,无中转开腹。与OS组相比,HALS组手术时间长[(110.9±37.2)min vs.(80.2±20.7)min,t=3.225,P=0.003],术中出血量少[(205.2±70.7)ml vs.(390.7±175.1)ml,t=-4.393,P=0.000],术后肛门排气早[(1.8±0.6)d vs.(2.4±0.9)d,t=-2.481,P=0.018],术后住院时间短[(8.9±1.2)d vs.(10.9±1.8)d,t=-4.134,P=0.000],术后并发症发生率差异无显著性[0(0例)vs.5.0%(1例),P=1.000]。结论 相比开腹手术,手助腹腔镜巨脾切除术具有切口美观、创伤小、恢复快的优点,是一种安全可行的治疗巨脾症的手术方式。     

Laparoscopic splenectomy in pediatric patients with hematologic diseases.

OBJECTIVE: The aim of this study was to evaluate our experience with laparoscopic splenectomy in pediatric patients with hematologic diseases. METHODS: A retrospective chart review was performed to analyze the following: indication for splenectomy, pre- and peri-operative management, surgical technique, complications, duration of hospitalization, and outcome. RESULTS: Eleven patients underwent laparoscopic splenectomy for the following indications: recurrent thrombocytopenia (<10,000) in seven with chronic immune thrombocytopenic purpura; anemia in two with hereditary spherocytosis; and hypersplenism in one and recurrent splenic sequestration in another with homozygous hemoglobin S. The six girls and five boys had a median age of 7 years. The median operative time was 180 minutes, and the median hospitalization was 72 hours. Among the patients with immune thrombocytopenic purpura (median platelet count, 153,000), those patients (n=3) with platelet counts of <100,000 did not suffer any bleeding complications. The patient with hypersplenism and homozygous hemoglobin S required a small incision in the left lower quadrant to facilitate removal of a 558-gram spleen. This patient also underwent cholecystectomy for cholelithiasis. The operative time was 295 minutes, and he was hospitalized for 5 days because of atelectasis. CONCLUSIONS: Laparoscopic splenectomy is a safe and effective procedure in children with hematological disorders.