Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciencesВестник Российской академии медицинских наук0869-60472414-3545"Paediatrician" Publishers LLC48810.15690/vramn.v70.i4.1406PEDIATRICS: CURRENT ISSUESАКТУАЛЬНЫЕ ВОПРОСЫ ПЕДИАТРИИHyposlenism After SplenectomyПостспленэктомический гипоспленизмMorozovD. A.МорозовДмитрий Анатольевич
Russian Federation

Moscow

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

damorozov@list.ruKlyuevS. A.КлюевСергей Александрович
Russian Federation

Moscow

врач-детский хирург, аспирант НЦЗД,

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

sergey1klyuev@yandex.ruScientific Centre of Children’s HealthНаучный центр здоровья детейSechenov First Moscow State Medical UniversityПервый МГМУ им. И.М. Сеченова290920157044134182809201528092015Copyright ©; 2015, "Paediatrician" Publishers LLCCopyright ©; 2015, Издательство "Педиатръ"2015"Paediatrician" Publishers LLCИздательство "Педиатръ"https://vestnikramn.spr-journal.ru/jour/about/submissionshttps://vestnikramn.spr-journal.ru/jour/article/view/488

Splenectomy is a serious operation, which includes the removal of the largest peripheral immune organ. Vast array of different pools of immunocompetent cells and immune-factors eliminate from the body as a result of this operation. Occurrence of hyposplenism in our country pediatric service is not determined — there are neither clear criteria for its diagnosis, nor approved algorithms for prevention. Data of postsplenectomy sepsis incidence in Russia are unknown. In this review article authors give contemporary literature data relating to the issue of developing hyposplenism and changes in the body after removal of spleen. Systemic effect of organ-resecting operation and the basic directions of overwhelming post-splenectomy infection and sepsis prevention are discussed.

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.

splenectomyhyposplenismpostsplenectomy sepsisprevention of hyposplenismспленэктомиягипоспленизмпостспленэктомический сепсиспрофилактика гипоспленизма1. 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.