不明原因发热伴脾肿大时脾切除术的临床意义

目的　探讨不明原因发热伴脾肿大时脾切除术病理学检查的临床意义。方法　回顾分析了我院血液内科1996年以来以不明原因发热收住院,除发热、脾肿大外无其他明显阳性体征,且辅助检查也不能做出病因诊断的35例患者的临床资料,所有患者均行剖腹探查加脾切除术,并获得病理学检查结果。结果　35例患者中,非霍奇金淋巴瘤17例(占486%),霍奇金淋巴瘤5例,恶性组织细胞病2例,结缔组织病5例,慢性淤血性脾肿大2例,噬血细胞综合征、脾陈旧性梗死、脾结核和脾血管肉瘤各1例。结论　发热伴脾肿大而不能明确诊断时,应动员患者尽早作诊断性脾切除术并送病理学检查,以免延误诊断和治疗。

The clinical application of splenectomy in pyrexia of unknown origin with splenomegaly

OBJECTIVE: To observe the clinical value of splenectomy for pathologic diagnosis in fever of unknown origin with splenomegaly only. METHODS: The pathologic findings of 35 patients with fever of unknown origin and splenomegaly treated by splenectomy, admitted in to the department of hematology in our hospital since 1996 were studied retrospectively. For these patients, there were no other positive signs except splenomegaly and the routine tests could not help us make the etiological diagnoses. RESULTS: In these 35 patients, there were 17 cases of non-Hodgkin's lymphoma (48.6%), 5 cases of Hodgkin's disease (14.2%), 2 cases of malignant histiocytosis (5.7%), 5 cases of connective tissue disease (14.2%), 2 cases of chronic congestive splenomegaly (5.7%), 1 case of hemophagocytic syndrome (2.9%), 1 case of remote spleen infarction (2.9%), 1 case of tuberculosis of spleen (2.9%) and 1 case of spleen angiosarcoma (2.9%). CONCLUSION: When only splenomegaly is found in patients with fever of unknown origin, it is necessary to persuade the patients to accept diagnostic splenectomy for pathological as soon as possible, otherwise, the diagnosis and treatment may be delayed.