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Incidental splenic injury during abdominal vascular surgery: A case-controlled analysis

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 2000年第1期190卷 58-64页

作者： Eaton, MA Valentine, J Jackson, MR Modrall, G Clagett, P Univ Texas SW Med Ctr Div Vasc Surg Dept Surg Dallas TX 75235 USA Dallas Dept Vet Affairs Med Ctr Dallas TX USA

Background: The small but finite risk of postsplenectomy sepsis is generally regarded as a firm indication for splenic preservation after iatrogenic injury, especially in the young. But splenectomy may be preferable in patients who sustain splenic injuries during vascular operations because of the potential for continued bleeding associated with anticoagulation. The purpose of this study was to determine the perioperative morbidity of incidental splenectomy among patients undergoing abdominal vascular operations. Study Design: We studied 17 patients who underwent incidental splenectomy at the time of abdominal vascular operations. Complete data collected on each subject included preoperative and postoperative blood counts, operative indications and details, transfusion requirements, length of hospital stay, and outcomes, Using age- and gender-matched case controls undergoing identical vascular operations from the same period, we evaluated the complication rate and outcomes of patients who underwent splenectomy for iatrogenic injuries of the spleen, versus those who did not sustain splenic injuries. Results: The estimated prevalence of iatrogenic splenic injury during the study period was 0.5%. Mean operative time, estimated blood loss, and duration of mechanical ventilation tended to be greater in the splenectomy patients, but the differences did not achieve statistical significance. Splenorrhaphy was attempted in seven patients, but continued bleeding mandated spleen removal in all cases. Splenectomy patients had a higher transfusion requirement (p = 0.03) and a longer mean length of stay (p = 0.03) than controls. Compared with controls, there was a higher prevalence of infectious complications in the splenectomy patients (p = 0.015), but there was no difference in the prevalence of thromboembolic complications between groups. Two of the splenectomy patients died in the postoperative period from multisystem organ failure, and one died of a missed splenic injury. Co

关键词：输血/统计学和数值数据病例对照研究医原性疾病手术中并发症/流行病学住院时间/统计学和数值数据年患病率手术后并发症/流行病学患病率脾/损伤脾切除术/统计学和数值数据血管外科手术老年人女(雌)性人类男(雄)性

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Laparoscopic splenectomy in patients with hematologic malignancies - Discussion

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AMERICAN JOURNAL OF SURGERY 1999年第6期178卷 536-536页

作者： Berman, RS Department of Surgical Oncology University of Texas M.D. Anderson Cancer Center Houston 77030 USA

Background: Although laparoscopic splenectomy (LS) for benign hematologic disease is well accepted, its role in hematologic malignancies is not clearly defined. This study examined the efficacy and feasibility of LS for hematologic ***: Records were reviewed from patients who underwent LS at two university hospitals. Charts from 77 open splenectomies for malignancy (OM) during the same period were also ***: Fifty-three patients underwent LS, 22 for hematologic malignancies (LM) and 31 for benign hematologic disorders (LB). Median splenic weight was greater in the LM group (930 g) than in the LB group (164 g, P = 0.001). LM was associated with longer operations and greater blood loss than was LB. LM had a 41% conversion rate. Morbidity, mortality, and transfusion rates were similar. Median hospital stay was shorter for LM (4 days) than for OM (6 days, P = 0.001).Conclusions: LS is feasible in hematologic malignancies but is associated with increased operative time and blood loss and a high conversion rate. Morbidity and mortality, however, was similar. Shorter hospital stays for LM compared with OM may translate into earlier recovery and initiation of antineoplastic therapy.

关键词：失血手术可行性研究血液病/外科学血液肿瘤/外科学腹腔镜检查/方法腹腔镜检查/统计学和数值数据住院时间/统计学和数值数据回顾性研究安全脾切除术/方法脾切除术/统计学和数值数据时间因素成年人女(雌)性人类男(雄)性中年人

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Therapeutic splenectomy in immune thrombocytopenic purpura

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WORLD JOURNAL OF SURGERY 2000年第1期24卷 92-94页

作者： Wani, NA Parray, FQ SheriKashmir Inst Med Sci Dept Surg Srinagar 190011 Jammu & Kashmir India

The effects of splenectomy in 41 patients managed from 1982 to 1995 at Sher-i-Kashmir Institute of Medical Sciences, Srinagar (Jammu and Kashmir), India, were studied. Immune thrombocytopenic purpura (ITP) was the main indication for therapeutic splenectomy among all the hematologic disorders. The mean age was 30 years (range 7-64), and the male to female ratio was 1.05:1. The mean platelet count in the preoperative period was 31,751/mm(3) (range 4000-85,000). All patients presented with thrombocytopenia, i.e., platelet count of <100,000/mm(3). In addition, 5 patients presented with anemia, i.e., Hb <10 g%. Among the patients with thrombocytopenia, 30 patients presented with counts <50,000/mm3 and II patients presented with counts between 50,000-100,000/mm3. None of the patients presented with leukopenia. The morbidity observed was 15% and mortality was 2%. The response to splenectomy was complete for thrombocytopenia in 3 patients and partial in 5 patients;4 patients failed to show any response. In anemic patients, 4 patients showed complete response and 1 patient showed no response. The prognosis was excellent in patients with platelet count >50,000/mm(3), age <50 years, no concomitant disease, and disease of shorter duration.

关键词：输血手术后并发症/流行病学预后紫癜血小板减少性特发性/血液紫癜血小板减少性特发性/并发症紫癜血小板减少性特发性/外科学回顾性研究脾切除术/统计学和数值数据治疗结果青少年成年人儿童女(雌)性人类男(雄)性中年人

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Gastric cancer: D2 all over again

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ANNALS OF SURGICAL ONCOLOGY 2003年第3期10卷 206-207页

作者： Douglass, HO New York State Dept Hlth Roswell Pk Canc Inst Buffalo NY 14263 USA

Why do reports from large volume single institutions continue to demonstrate low operative mortalities, short hospital stays, and prolonged patient survivals for patients with gastric cancer treated by D2 lymphadenectomy when randomized trials show no survival advantage and increased operative mortality with this procedure? Should gastric cancer resections be added to the growing list of procedures with reduced mortality and improved survivorship when performed in high-volume institutions? Although not a randomized trial, the report by Dr. Sierra and colleagues from the University of Navarra in Paploma, Spain, adds credence to the concept that D2 resections can be performed safely and provide enhanced survival when performed in high-volume hospitals by a small group of experienced surgeons.1,2 The D2 dissection that they performed included total gastrectomy and splenectomy but did not require resection of the tail of the pancreas as performed in the Dutch and British randomized trials.3,4 Instead, lymph nodes along the splenic artery (station 11 in the Japanese classification) were usually dissected away from surrounding tissues to be included with the resected specimen. Pancreatic fistulas did occur in three of the eight D2 patients who required pancreatic resection. This suggests that, in the randomized trials, the pancreatic resection, rather than the splenectomy and the D2 lymphadenectomy, was the major cause of the excess operative mortality in the D2 group.3,4

关键词：胃切除术/方法胃切除术/标准胃切除术/统计学和数值数据医院死亡率淋巴结切除术/方法淋巴结切除术/标准淋巴结切除术/统计学和数值数据淋巴转移胰腺切除术/方法胰腺切除术/标准胰腺切除术/统计学和数值数据手术后并发症预后可重复性结果脾切除术/方法脾切除术/标准脾切除术/统计学和数值数据胃肿瘤/病理学胃肿瘤/外科学幸存治疗结果人类

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