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首页> 外文期刊>British Journal of Haematology >Short- and long-term risks of splenectomy for benign haematological disorders: Should we revisit the indications?
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Short- and long-term risks of splenectomy for benign haematological disorders: Should we revisit the indications?

机译：良性血液系统疾病脾切除术的短期和长期风险：我们应该重新考虑适应症吗？

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摘要

Splenectomy has represented a key treatment option in the treatment of many benign haematological diseases, including immune thrombocytopenia (ITP) and disorders associated with ongoing haemolysis (thalassaemia major and intermedia, sickle cell disease, and hereditary or acquired haemolytic anaemias). Improvements in surgical techniques have reduced perioperative complications and mortality. Preventive measures (new protein conjugate vaccines, antibiotic prophylaxis, and increased vigilance) are thought to greatly reduce the risk of overwhelming post-splenectomy infection (OPSI), although their implementation is inconsistent. Nevertheless, there is increasing documentation of the short- and long-term risks of splenectomy, which vary according to the underlying indication. Splenectomized patients are at increased risk of venous thromboembolism, particularly within the splenoportal system. The long-term thromboembolic risk is higher in haematological disorders associated with ongoing haemolysis, particularly in thalassaemia intermedia, which has led to a more conservative approach. In comparison, patients with ITP appear to be at lower risk of adverse effects of splenectomy, which maintains its place as the potentially most curative and safe second-line treatment. However, a splenectomy-sparing approach is also emerging for ITP, and recent guidelines recommend that this procedure is deferred until ≥12 months from ITP diagnosis, to allow sufficient time for possible remission.
机译：脾切除术已成为许多良性血液病治疗的关键治疗选择，包括免疫性血小板减少症（ITP）和与正在进行的溶血相关的疾病（重度地中海贫血和中间型，镰状细胞病以及遗传性或后天性溶血性贫血）。外科技术的改进降低了围手术期并发症和死亡率。预防措施（新蛋白结合疫苗，抗生素预防措施和提高警惕性）被认为可以大大降低脾切除术后感染（OPSI）的危险，尽管其实施方式不一致。然而，越来越多的关于脾切除术的短期和长期风险的文献，根据潜在的适应症而有所不同。脾切除术的患者发生静脉血栓栓塞的风险增加，尤其是在脾门系统内。与正在进行的溶血相关的血液系统疾病（尤其是中间地中海贫血）的长期血栓栓塞风险较高，这导致采取了更为保守的方法。相比之下，ITP患者脾切除术的不良反应风险较低，因此，作为潜在的最具治愈性和安全性的二线治疗，它的地位仍然保持不变。但是，ITP的脾切除术也正在兴起，最近的指南建议将该程序推迟到ITP诊断后≥12个月，以便有足够的时间来缓解。

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