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Постспленэктомический гипоспленизм

https://doi.org/10.15690/vramn.v70.i4.1406

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Аннотация

Спленэктомия — это серьезная иммунокомпрометирующая операция, т.к. в результате нее удаляется наиболее крупный периферический орган иммунной системы, из организма выносится огромный массив пулов различных иммуннокомпетентных клеток и иммунноактивных факторов, страдают и специфические, и неспецифические врожденные звенья иммунитета. Место гипоспленизма в педиатрии в России не определено: не существует ни четких критериев его диагностики, ни утвержденных алгоритмов профилактики. Статистические данные о частоте развития постспленэктомического сепсиса в России отсутствуют. В данной обзорной статье авторы приводят современные литературные данные относительно вопросов гипоспленизма и изменений, развивающихся в организме после удаления селезенки. Обсуждается системный эффект органоуносящей операции, рассматриваются основные направления профилактики отягощенной постспленэктомической инфекции и сепсиса как крайней степени проявления гипоспленизма.

Об авторах

Дмитрий Анатольевич Морозов
Научный центр здоровья детей; Первый МГМУ им. И.М. Сеченова
Россия

доктор медицинских наук, профессор, директор НИИ детской хирургии НЦЗД;

заведующий кафедрой детской хирургии и урологии-андрологии,

119991, Москва, Ломоносовский пр-т, д. 2, стр. 1



Сергей Александрович Клюев
Научный центр здоровья детей
Россия

врач-детский хирург, аспирант НЦЗД,

119991, Москва, Ломоносовский пр-т, д. 2, стр. 1



Список литературы

1. Filippov D.V. Sovremennye metody diagnostiki i lecheniya zakrytykh izolirovannykh povrezhdenii selezenki u detei. Avtoref. dis. … kand. med. nauk [Modern Methods of Diagnosis and Treatment of Closed Isolated Splenic Injuries in Children. Author’s abstract]. St. Petersburg, 2011. 26 p.

2. Chanyshev B.F. Splenoz i mezenterial'naya limfadenopatiya kak kompensatornye mekhanizmy postsplenektomicheskogo sindroma pri travmaticheskikh povrezhdeniyakh selezenki. Avtoref. dis. … kand. med. nauk [Splenosis and Mesenteric Lymphadenopathy as a Compensatory Mechanism Post-splenectomy Syndrome in Traumatic Injuries of the Spleen. Author’s abstract]. Ufa, 2011. 23 p.

3. Struchko G.Yu. Morfofunktsional'noe issledovanie timusa i immunobiokhimicheskikh pokazatelei krovi posle splenektomii i immunokorrektsii. Avtoref. dis. ... dokt. med. nauk [Morphofunctional Study of Immunobiochemical Thymus and Blood Parameters after Splenectomy and Immunomodulation. Author’s abstract]. Saransk, 2003. 23 p.

4. Sclafani S.J.A., Shaftan G.W., Scalea T.M. Non-operative salvage of computed tomography diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis. J. Trauma. 1995; 39: 818–827.

5. Haan J.M., Bochicchio G.V., Kramer N. Non-operative management of blunt splenic injury: a 5 year experience. J. Trauma. 2005; 58: 492–498.

6. Dent D., Alsabrook G., Erickson B.A., Myers J., Wholey M., Stewart R. Blunt splenic injuries: high non-operative management rate can be achieved with selective embolization. J. Trauma. 2004; 56 (5): 1063–1067.

7. Zhan X.L., Ji Y., Wang Y.D. Laparoscopic splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension. World J. Gastroenterology. 2014; 20 (19): 794– 800.

8. Xin Z., Qingguang L., Yingmin Y. Total laparoscopic versus open splenectomy and esophagogastric devascularization in the management of portal hypertension: a comparative study. Digestive Surgery. 2009; 26: 499–505.

9. Bo W., He-Shui W., Guo-Bin W., Kai-Xiong T. Laparoscopy splenectomy for massive splenomegaly. J. Invest. Surg. 2013; 26 (3): 154–161.

10. Héry G., Becmeur F., Méfat L., Kalfa D., Lutz L., Guys J.M., de Lagausie P. Laparoscopic partial splenectomy: indications and results of a multicenter retrospective study. Surg. Endosc. 2008; 22 (1): 45–49.

11. Makrin V., Avital S., White I., Sagie B., Szold A. Laparoscopic splenectomy for solitary splenic tumors. Surgic. Endosc. 2008; 22 (9): 2009–2012.

12. Walsh R.M., Brody F., Brown N. Laparoscopic splenectomy for lymphoproliferative disease. Surg. Endosc. 2004; 18 (2): 272–275.

13. Hollingsworth C.L., Rice H.E. Hereditary spherocytosis and partial splenectomy in children: review of surgical technique and the role of imaging. Pediatr. Radiol. 2010; 40 (7): 1177–1183.

14. Al-Salem A.H, Nasserulla Z. Splenectomy for Children with Thalassemia. Am. J. Hematol. 2003; 72: 94–98.

15. Rijcken E., Mees S.T., Bisping G., Krueger K., Bruewer M., Senninger N. Laparoscopic splenectomy for medically refractory immune thrombocytopenia (ITP): A retrospective cohort study on longtime response predicting factors based on consensus criteria. Int. J. Surg. 2014; 12 (12): 1428–1433.

16. Melles D.C., de Marie S. Prevention of infections in hyposplenic and asplenic patients: an update. Neth. J. Med. 2004; 62: 45–52.

17. Takehiro Okabayashi, Kazuhiro Hanazaki. Overwhelming postsplenectomy infection syndrome in adults — a clinically preventable disease. World J. Gastroenterology. 2008; 14 (2): 176–179.

18. Connell N.T., Brunner A.M., Kerr C.A., Schifman F.J. Splenosis and sepsis. The born again spleen provides poor protection. Virulence. 2011; 2 (1): 4–11.

19. Eibl M. Immunological consequences of splenectomy. Prog. Pediatr. Surg. 1985; 18: 139–145.

20. Weintraub L.R. Splenectomy: who, when, and why? Hospital practice. 1994; 29: 27–34.

21. Dameshek W. Hyposplenism. J. Am. Med. Assoc. 1955; 157: 613.

22. William B.M., Thawani N., Sae-Tia S., Corazza G.R. Hyposplenism: a comprehensive review. Part II. Clinical manifestations, diagnosis and management. Hematology. 2007; 12: 89–98.

23. Sabatino A.D., Carsetti R., Corazza G.R. Post splenectomy and hyposplenic states. Lancet. 2011; 378: 86–97.

24. Apartsin K.A. Pathogenic mechanisms of postoperative hyposplenism and ways of treatment. Bull. Int. Sci. Surg. Assoc. 2006;1(2):11–12.

25. Lepekhova S.A., Apartsin K.A., Prokop'ev M.V. Inflammatory liver damage after asplenizatsii. Infektsii v khirurgii = Infections in surgery. 2008;6(App.1):40–41.

26. Styrt B. Infection associated with asplenia: risks, mechanisms and prevention. Am. J. Med. 1990; 88: 33–42.

27. Yildiz A.E., Ariyurek M.O., Karcaaltincaba M. Splenic anomalies of shape, size, and location: pictorial essay. Scientific World J. 2013; Article ID 321810: 9.

28. Kalinina N.M., Ketlinskii S.A., Okovityi S.V., Shulenin S.N. Zabolevaniya immunnoi sistemy. Diagnostika i farmakoterapiya [Diseases of Immune System. Diagnosis and Pharmacotherapy]. Moscow, Eksmo, 2008. 496 p.

29. Grigor'ev E.G., Apartsin K.A., Belykh G.K. Khirurgiya povrezhdenii selezenki [Surgery Spleen Damage]. Irkutsk, IGMU, 1996. 216 p.

30. Moskvichev E.V., Merkulova L.M., Struchko G.Yu. Morphology and immunohistochemical phenotype of the thymus in the secondary immune deficiency after splenectomy. Elektronnyi nauchnyi zhurnal. Sovremennye problemy nauki i obrazovaniya = Electronic scientific journal. Modern problems of science and education. 2012;3. Available at: http://www.science-education.ru/103-r6313 (accessed: 04.08.2015).

31. Organosokhranyayushchaya khirurgiya selezenki. Pod red. E.G. Grigor'eva, K.A. Apartsina [Organ Sparing Surgery of the Spleen. Edited by E.G. Grigor'ev, K.A. Apartsin]. Novosibirsk, Nauka, 2001. 400 p.

32. Lockwood C.M. Immunological functions of the spleen. Clin. Haematol. 1983; 12: 449–465.

33. Spirer Z., Zakuth V., Diamant S., Mondorf W., Stefanescu T., Stabinski Y., Fridkin M. Decreased tuftsin concentrations in patients who have undergone splenectomy. Brit. Med. J. 1977; 2 (6102): 1574–1576.

34. Ali Y.M., Lynch N.J., Rajakumar K., Kadioglu A., Stover C.M., Schwaeble W.J. The lectin path way of complement activation is a critical component of the innate immune response to pneumococcal infection. PLoS Pathogens. 2012; 8 (7): 1–11.

35. Mendel L.B., Holmes C. Jackson. On uric acid formation after splenectomy. Am. J. Physiol. 1900; 4: 163–169.

36. Farrell R.J., Peppercorn M.A. Ulcerative colitis. Lancet. 2002; 359: 331–341.

37. Bradshaw P.H., Thomas C.G., Jr. Partial splenectomy and overwhelming infection in rats. J. Surg. Res. 1982; 32: 173–175.

38. Wolber F.M., Leonard E., Michael S., Orschell-Traycoff C.M., Yoder M.C., Srour E.F. Roles of spleen and liver in development of the murine hematopoietic system. Exp. Hematol. 2002; 30 (9): 1010–1019.

39. Malov A.G., Alekseev S.V., Platonov A.A., Alekseev V.S. Thrombocytosis after splenectomy in children. Vestnik khirurgii im. I.I. Grekova = I.I. Grekov Bulletin of surgery. 2008;4:53–55.

40. Natsional'noe obshchestvo detskikh gematologov, onkologov. Natsional'noe obshchestvo gematologov. Federal'nye klinicheskie rekomendatsii po diagnostike i lecheniyu nasledstvennogo sferotsitoza [National Society of Pediatric Hematologists, Oncologists. National Society of Hematologists. Federal Guidelines for the Diagnosis and Treatment of Hereditary Spherocytosis]. Moscow, Media Medika, 2013. 104 p.

41. Kirichuk V.F., Maslyakov V.V., Barsukov V.G. Changes in the rheological properties of blood after splenectomy in the immediate postoperative period. Annaly khirurgii = Annals of Surgery. 2007;1:36–38.

42. Barsukov V.G. Reologicheskie svoistva krovi v blizhaishem posleoperatsionnom periode pri travme selezenki. Avtoref. dis. … kand. med. nauk [Rheological Properties of Blood in the Immediate Postoperative Period in the Spleen Injury. Author’s abstract]. Saransk, 2009. 44 p.

43. Corazza G.R., Ginaldi L., Zoli G., Frisoni M., Lalli G., Gasbarrini G., Quaglino D. Howell–Jolly body counting as a measure of splenic function. A reassessment. Clin. Lab. Haematol. 1990; 12 (3): 269–275.

44. King H., Schumacker H.B. Splenic studies. Susceptibility to infection after splenectomy performed in infancy. Ann. Surg. 1952; 136: 239–242.

45. Hansen K., Singer D.B. Asplenic hyposplenic overwhelming sepsis: Postsplenectomy sepsis revisited. Ped. Dev. Path. 2001; 4: 105–121.

46. Waghorn D.J. Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed. J. Clin. Pathol. 2001; 54: 214–218.

47. Sandra L., Moffett P.C. Overwhelming postsplenectomy infection: Managing patients at risk. J. Am. Acad. Physician Assistants. 2009; 22 (7): 36–40.

48. Uranüs S., Pfeifer J. Non-operative management of blunt splenic injury. World J. Surg. 2001; 25: 1405–1407.

49. Morgan T.L., Tomich E.B. Overwhelming. Post splenectomy infection (OPSI). A Case Report and Review of the Literature. J. Emerg. Med. 2012; 43 (4): 758–763.

50. Livingston C.D., Levine B.A., Sirinek K.R. Preservation of splenic tissue prevents postsplenectomy pulmonary sepsis following bacterial challenge. J. Surg. Res. 1982; 33: 356–361.

51. Brigden M.L., Pattullo A.L., Brown G. Pneumococcal vaccine administration associated with splenectomy: the need for improved education, documentation, and the use of a practical checklist. Am. J. Hematol. 2000; 65: 25–29.

52. Kinnersley P., Wilkinson E., Srinivasan J. Pneumococcal vaccination after splenectomy: survey of hospital and primary care records. BMJ. 1993; 307 (6916): 1398–1399.

53. White K.S., Covington D., Churchill P., Maxwell J.G., Norman K.S., Clancy T.V. Patient awareness of health precautions after splenectomy. Am. J. Infect Control. 1991; 19: 36–41.

54. Hegarty P.K., Tan B., O’Sullivan R., Cronin C.C., Brady M.P. Prevention of postsplenectomy sepsis: how much do patients know? Hematol. J. 2000; 1: 357–359.

55. Jockovich M., Mendenhall N.P., Sombeck M.D., Talbert J.L., Copeland E.M., 3rd, Bland K.I. Long term complications of laparotomy in Hodgkin’s disease. Ann. Surg. 1994; 219: 615–621.

56. Davies J.M., Lewis M.P., Wimperis J., Rafi I., Ladhani S., Bolton-Maggs P.H. Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen: Prepared on behalf of the British Committee for Standards in Haematology by a Working Party of the Haemato-Oncology Task Force. Brit. J. Haematol. 2011; 155 (3): 308–317.


Для цитирования:


Морозов Д.А., Клюев С.А. Постспленэктомический гипоспленизм. Вестник Российской академии медицинских наук. 2015;70(4):413-418. https://doi.org/10.15690/vramn.v70.i4.1406

For citation:


Morozov D.A., Klyuev S.A. Hyposlenism After Splenectomy. Annals of the Russian academy of medical sciences. 2015;70(4):413-418. (In Russ.) https://doi.org/10.15690/vramn.v70.i4.1406

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