Comparative hematologic and immunologic studies of patients with splenectomy and spleen autotransplantation

We compared changes in haematological and immunological parameters of patients with splenectomy (n=24), splenectomy plus spleen autotransplantation (n=12) and healthy controls (n=23). In the autotransplantation group pieces of the removed spleen were placed into the omentum with good visible circulation. Significant alterations in the hematological status and in some immunological parameters were observed in both groups of patients who were operated on compared to those in the control group. There was no difference, however, between the results of the two groups of operated patients. Therefore, we emphasize the importance of vaccination in patients with spleen autotransplantation in order to prevent potential sepsis. In addition, we recommend the possible further use of spleen autotransplantation.     

Hemorheological follow-up after splenectomy and spleen autotransplantation in mice

We previously reported on a spleen autotransplantation model in mice, with spleen function studies at 6 weeks. The present study was undertaken to investigate long-term hemorheological functions. A/J and BALB/c inbred mice were divided into four groups: control, sham surgery (SH), splenectomy (SE), and spleen autotransplantation (AU). Hematological and hemorheological parameters were determined. Leukocyte counts in the SE and AU groups were significantly higher than in controls, while hematocrit levels were markedly lower. Mean erythrocyte volume did not change significantly. Platelet counts in the AU group were significantly lower, and red blood cell deformability was significantly worse in the SE group. The AU group also had increased cell transit time, but it was less than that in the SE group. The SE group showed the highest fibrinogen levels. We conclude that there are some consistent differences in hematological parameters between splenectomy and spleen autotransplantation. These data suggest that spleen autotransplantation may partially restore hemorheological functions following splenectomy.     

手助腹腔镜脾切除与开腹脾切除对机体术后免疫功能影响的比较

目的研究手助腹腔镜脾切除术和开腹脾切除对机体免疫功能的影响,考察该术式的临床价值。方法16例肝硬化脾亢患者随机分为手助腹腔镜脾切除组和开腹脾切除组,比较两组病例术前、术后1d、3d、7d外周血淋巴细胞亚群的变化。结果开腹组术后1d、3d、7d的成熟淋巴细胞(CD3)、辅助淋巴细胞(CD4)及CD4与抑制性T淋巴细胞(CD8)的比值与术前相比明显下降(P<0.05或P<0.01)。而腹腔镜组术后1d、3d、7d的CD3、CD4、CD4/CD8与术前相比没有显著差异(P>0.05)。结论手助腹腔镜脾切除术结合了微创外科和传统开腹手术的优点,具有安全、创伤小、恢复快的特点,具有很好的临床应用价值和前景。     

Distribution of peripheral blood cells in mice after splenectomy or autotransplantation

Our aim was to compare the distribution changes of peripheral leukocytes and erythrocytes in splenectomized and spleen-autotransplanted BALB/c female mice (n = 96), 2 and 8 months after surgery. In total, there were eight groups of animals: splenectomy, autotransplantation, sham, and untreated controls at both time points. We used the spleen-apron method of Furka et al. (Khirurgiia (Mosk) 1989;9:125-127), inserting five spleen chips into the greater omentum, for autotransplantation. Quantitative and qualitative blood cell counts and the phagocytic activity of cells (stimulated with zymosan) were determined. In splenectomized animals, the number of neutrophils significantly increased 8 months after surgery. The greatest phagocytic activity of neutrophils, however, was observed in autotransplanted animals of the same age. In splenectomized animals, erythrocyte volumes were significantly higher in the second postoperative month, but normalized by the eighth month. In conclusion, spleen autotransplantation has some beneficial effects, including clearing erythrocytes and preserving the phagocytic activity of neutrophils in peripheral blood.     

Spleen autotransplantation. Morphological and functional follow-up after spleen autotransplantation in mice: a research summary

In 1986, we started the research on spleen surgery aimed at saving the splenic mass after its traumatic injury, with elaboration of special resection and autotransplantation techniques. The researches started on mongrel dogs and were continued on inbred mice and beagle dogs with complex histological, imaging, and laboratory investigations, following-up the function and the regeneration of autotransplanted spleen chips. Performing research on mice provided more immunological methods, such as lymphocyte subsets, immunoglobulin levels, and monitoring the phagocytic functions. Researches showed evidence also on the presence of apoptosis, furthermore, stem cell studies on regeneration and functional restoration of the spleen chips are in progress. Our results contributed to two multidisciplinary guidelines in Hungary: (1) One of them is under preparation and underlines the importance of spleen saving methods after traumatic splenic injury; (2) The second guideline shows that hemorheological changes can be early indicators of the increased sensitivity to postsplenectomy infections.     

The immunological studies on the splenectomy and the splenic autotransplantation in BALB/C mice

Recently, it has been demonstrated that the severe infectious diseases are often caused after splenectomy. The significance of spleen on humoral immunity has been pointed out, however the alterations of cellular immunity by splenectomy has not yet been investigated sufficiently. In this study, the effects of splenectomy on the immunological aspects were examined. And the reconstruction of immunological responses by the splenic autotransplantation was also examined. The results obtained were as follows. The antibody titers against SRBC of the splenectomized groups continued to be apparently lower than those of sham-operated groups. The IgM of the splenectomized groups showed lower values than that of the sham-operated groups, but concerning IgG, no distinct differences were noticed among these two groups. On the proliferation of peripheral lymphoid cells, the splenectomized groups from 4th week later showed a higher response than the sham operated groups. The splenic autotransplanted groups showed a similar response to the sham operated ones in the antibody production against SRBC, and the proliferations of lymphocytes. The splenic autotransplantation might be suggested to be a worthy application.     

腹腔镜下二级脾蒂离断法与内镜下切割吻合器脾切除术的对比分析

目的 对比研究二级脾蒂离断法与内镜下切割吻合器(Endo-GIA)法在腹腔镜脾切除术中的应用,以评价腹腔镜脾切除术在临床推广应用的可行性.方法 2002年1月至2011年10月间腹腔镜脾切除术40例,其中14例采用Endo-GIA法,24例采用二级脾蒂离断法.结果 40例腹腔镜脾切除术中有2例因术中出血难止、手术视野模糊而中转开腹,中转开腹率为5%,并且均为初次开展手术者.使用二级脾蒂离断法的患者留置引流时间、术后住院时间长于Endo-GIA法(P＜0.05),而住院费用明显低于Endo-GIA法(P＜0.05).两组手术时间、术中失血量、术后进食时间、第一天引流量比较,差异均无统计学意义(P>0.05).结论 采用解剖二级脾蒂离断法,免除了Endo-GIA的使用,该法有助于合理应用卫生资源,降低医疗成本,减轻患者经济和心理负担.     

Partial experimental autotransplantation of the spleen

The authors performed autotransplantation of the spleen in 45 dogs. They found that, the pieces of the transplanted spleen underwent necrosis, but new malphigian bodies formed on their surface. These latter took over the sepsis-inhibiting function of the spleen. Thus the grafting of spleen can be useful and worth doing. Spleen should be transplanted in thin slices since in case of a larger piece they may necrotize and give rise to abscesses.     

Laparoscopic splenectomy in the treatment of hematologic diseases

Laparoscopic approach to surgical procedures in children is used in different diseases, but there are some controversies for using this technique in the splenectomy. Laparoscopic surgery decreased pain, postoperative ileus and the hospital stay; and improve cosmetics, the most important disadvantage is the longer operating time. Splenectomy is indicated more in immune thrombocytopenic purpura (PTI) and hereditary espherocytosis (HE). We review our experience in laparoscopic spelenectomy.     

Posttraumatic autotransplantation of spleen tissue

Clinical and laboratory studies have documented high susceptibility to pneumococcal infection in asplenic humans and animals. Splenic autotransplantation has been suggested as a method of preserving function. Autotransplantation of irreparably damaged spleens in humans preserved splenic functions. Ten patients operated on for blunt abdominal trauma required unavoidable splenectomy. In each, autotransplantation of the removed spleen (roughly 50 g) was performed. Postoperative studies of splenic functions revealed disappearance of Howell-Jolly bodies from peripheral blood. Levels of IgM, which were initially significantly depressed, returned to normal and there were normal technetium Tc 99m sulfur colloid scans ten weeks after surgery. All patients are alive and healthy. Our data suggest that autotransplantation of spleen is a safe alternative method for preserving splenic function when total splenectomy is mandatory for hemostasis.     

Heterotopic autotransplantation of the spleen in animal experiments

A new technique of heterotopic autotransplantation of pieces of the spleen is suggested. It differs from the methods used previously in that the pieces of the autologous transplant are placed between the layers of the greater omentum and not on its surface. Not only was the viability of the pieces of the autologous transplant maintained but the hazard of intraabdominal adhesions and their unfavourable consequences was reduced to a great measure.     

Late results of splenectomy in hematologic disorders

During the past 27 years from 1944 to 1970 splenectomy was performed on 53 patients including 33 idiopathic thrombocytopenic purpura (ITP), 13 hereditary spherocytosis and 7 hypoplastic anemia. Their clinical and laboratory findings in immediate and late postoperative periods were compared with those received medical treatment alone. In the chronic form of ITP the effect of medical treatment alone is only transitory and not curative. Splenectomy seems to be the treatment of choice in this situation which produces long term favorable results regardless of patient's response to preoperative steroid treatment. In hereditary spherocytosis the improvement in the morphology of red blood cells was limited after splenectomy, but considerable improvement was achieved in hemolytic tendency. Therefore, splenectomy would be the first choice. In hypoplastic anemia splenectomy did not produce, in general, favorable results as compared in ITP or hereditary spherocytosis. However, when the patient responded to steroid treatment preoperatively, splenectomy could have reduced the frequency and amount of blood transfusion. Splenectomy would then be contemplated in such situations.     

腹腔镜巨脾切除术

目的: 探讨腹腔镜脾切除术治疗乙肝后肝硬化门静脉高压脾功能亢进的方法和疗效.方法: 对8例乙肝后肝硬化门静脉高压脾功能亢进患者采用腹腔镜脾切除术.在腹部放置3个套管,脾周韧带及脾门用超声刀解剖,脾门血管用Endo GIA夹闭离断.结果:8例病人均顺利完成腹腔镜脾切除术,无中转开腹,无术后并发症发生.术后血小板明显上升,从平均36×109/L[(17~56)×109/L]升至437×109/L[(316~624)×109/L],随访7~24个月血小板均大于100×109/L.结论: 超声刀、Endo GIA等先进技术的应用已使腹腔镜脾切除术成为治疗乙肝后肝硬化门静脉高压脾亢有效的手术方法.     

Partial splenectomy technique and some hematologic consequences in the dog

A simple, rapid, and reliable technique has been developed for partial splenectomy in the dog. There is a relationship between the amount of splenic tissue retained and the speed of return to normal values of blood cell elements.