血液病脾切除术的并发症  

Complications of splenectomy in patients with hematopathy

作　　者：高维生[1] 刘洪枫[1] 杨志英[1] 黄志峰[1] 唐伟松[1] 管珩[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院基本外科

出　　处：《中华普通外科杂志》1999年第2期113-115,共3页Chinese Journal of General Surgery

摘　　要：目的总结血液病患者脾切除术的手术指征、并发症和治疗效果。方法回顾性分析１９８６年～１９９５年间７５例血液病患者的脾切除术资料，其中良性血液病６５例，恶性血液病１０例。结果良性血液病的术中失血量、术后并发症与脾脏大小有关，常见术后并发症依次为肺部感染、膈下感染及术后出血，术后并发症发生率为２０％。手术后血液学参数改善的程度依次为遗传性球形红细胞增多症、原发性血小板减少性紫癜、自身免疫性溶血性贫血、原发性血小板减少性紫癜合并自身免疫性溶血性贫血。恶性血液病行脾切除术后，术后并发症发生率为５０％，且不能延长生存期。围手术期长期使用抗菌素未能降低手术感染率。结论脾切除术对良性血液病行之有效，对恶性血液病患者则需慎重。Objective To evaluate the indications,complications, and effect of splenectomy performed in patients suffering from hematopathy.Methods From 1986 to 1995,seventy five cases of hematopathy underwent splenectomy.Among them,65 were benign and 10 malignant.Results Blood loss during operation,complication and postoperative hemotological parameters were analysed. We found that bleeding and complication were less in benign hematopathy with smaller spleen. Postoperative complications developed in 20% of all cases,with pulmonary infection, subphrenic infection and postoperative bleeding as the most common events.In benign hematopathy,postoperative hemologic parameter improved in cases of hereditary spherocytosis,idiopathic thrombocytopenic purpura,autoimmune hemolytic anaemia and Evans syndrome in proper order.Complication of splenectomy for malignant hematopathy was severe (50%),and postoperative survival time was not prolonged. Long time use of antibiotics perioperatively could not reduce infectious complication.Conclusions Splenectomy is effective for benign hematopathy,while splenectomy performed in cases of malignant hematopathy must carefully balanced against its risk.Long term use of antibiotics has no impact on postsplenectomy infection.

关 键 词：脾切除 血液病 手术后并发症 

分 类 号：R733[医药卫生—肿瘤] R657.606[医药卫生—临床医学]