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脾脏是人体单核—巨噬细胞系统的重要器官之一,它是体内最大的二级淋巴器官,它产生B淋巴细胞(60%)和少量的T淋巴细胞(40%),并合成大量抗体。长期以来讨论了那些疾病属于脾切除的适应症,血液病进行脾切除的常见病有:特发性血小板减少性紫癜经内科治疗无效者,遗传性球形红细胞增多症,获得性溶血性贫血,地中海贫血,脾亢进性粒细胞减少或全血细胞减少,再障,何杰金氏病,类脂质沉着病(高雪氏、尼曼匹克氏病)慢性粒细胞性白血病等。随着手术适应症的增多,学者对术后的疗效、预后各有不同的看法,影响疗效与预后的关键在于如何预防严重的感染,是本文综述的目的。一、脓毒血症与死亡概况King氏等首先报导因遗传性球形红细胞增多症5例进行脾切除,其中4例发生败血症及暴发性脑膜炎而死亡。Eraklis报导461例因各种原因而行脾切除者,因患脓毒血症包括败血症和/或细菌性脑膜炎或暴发性肺炎,其死亡率达18%。但脾破裂而手术的死亡率仅0.5%,其他外伤性的亦不如地中海贫血、
The spleen is one of the most important organs in the human monocyte-macrophage system. It is the largest secondary lymphoid organ in the body. It produces B lymphocytes (60%) and a small amount of T lymphocytes (40%) and synthesizes a large amount of antibodies . Long-term discussions of those diseases are indications of splenectomy, common diseases of spleen resection of blood diseases are: idiopathic thrombocytopenic purpura ineffective medical treatment, hereditary spherocytosis, acquired hemolytic anemia, the Mediterranean Anemia, hypersplenism, neutropenia or pancytopenia, aplastic anemia, Hodgkin’s disease, lipoidosis (Gaucher’s, Niemann-Pick disease) and chronic myeloid leukemia. With the increase of surgical indications, scholars have different views on postoperative efficacy and prognosis. The key to influencing the curative effect and prognosis is how to prevent serious infections, which is the purpose of this review. First, the sepsis and death profile King first reported in 5 cases of hereditary spherocytosis splenectomy, of which 4 cases of sepsis and fulminant meningitis and death. Eraklis reported 461 patients who underwent splenectomy for various reasons, with a mortality rate of 18% due to sepsis, including sepsis and / or bacterial meningitis or fulminant pneumonia. However, the spleen rupture and surgical mortality was only 0.5%, other traumatic than thalassemia,