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1.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 29(2): 574-580, 2021 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-33812433

RESUMO

OBJECTIVE: To investigate the factors affecting the chronicity of childhood primary immune thrombo-cytopenia (ITP) and compare the efficiency of different first-line treatment regimens. METHODS: Children with ITP hospitalized in our hospital from September 2013 to October 2018 were retrospectively analyzed. RESULTS: Three hundred and one children (150 males and 151 females) were included in this study, with a median age of 8 (0.17-17) years old, and 110 (36.5%), 92 (30.6%), and 99 (32.9%) cases were grouped into newly diagnosed, persistent, and chronic ITP, respectively. The median of follow-up was 41.92 (1.07-74.03) months. At the end of the follow-up (October 2019), among the 202 newly diagnosed/persistent ITP children, 79 cases (59 newly diagnosed and 20 persistent ITP) achieved remission within 1 year after initial diagnosis, with a remission rate of 39.3%; 122 cases (50 newly diagnosed and 72 persistent ITP) developed chronic disease, with a chronicity rate of 60.7%; one case underwent splenectomy. In 99 cases with chronic ITP, 5 cases underwent splenectomy. Multivariable logistic regression analysis showed that, the insidious onset of symptoms (OR=3.754, 95%CI: 1.882-7.488, P=0.000) increased the risk of chronicity, while the positive antibody to anti-platelet membrane glycoprotein (OR=0.446, 95%CI: 0.224-0.888, P=0.021) might reduce the risk of chronicity. And no difference was found by the analysis of subtype of anti-platelet membrane glycoprotein (P=0.305). The efficacy of the first-line treatment of intravenous immunoglobulin (IVIG) alone or combined with steroid was better than that of steroid alone (P=0.028, 0.028), however, the efficiency was not significantly different between IVIG alone and combined with steroid (P=0.086). CONCLUSION: Insidious onset of symptoms in pediatric ITP increases the risk of chronicity, while the positive titer of anti-platelet membrane glycoprotein may reduce the risk. In the first-line treatment for the newly diagnosed/persistent children. The efficacy of IVIG alone or combined with steroid is better than that of steroid alone.


Assuntos
Púrpura Trombocitopênica Idiopática , Adolescente , Criança , Criança Hospitalizada , Feminino , Humanos , Imunoglobulinas Intravenosas , Masculino , Estudos Retrospectivos , Esplenectomia
2.
Pan Afr Med J ; 38: 144, 2021.
Artigo em Francês | MEDLINE | ID: mdl-33912314

RESUMO

Congenital cystic disease of the biliary tree is a known risk factor for gallbladder cancer. We here report a case of squamous cell carcinoma of the bile duct (BD) complicating a cystic dilatation of the bile ducts in a 54-year-old woman hospitalized for biliary pancreatitis. Abdominal scanner showed nodular thickening of the fundus of the gallbladder and fusiform dilation of the cystic duct and the main bile duct (VBP) with lesion of the tail of the pancreas, initially suggesting mucinous cystadenoma. Extended cholecystectomy involving the gallbladder fossa with resection of the distal biliary tract, choledocoduodenal anastomosis with caudal splenopancreatectomy + drainage were performed. Histopathological examination of the gallbladder mass revealed moderately differentiated invasive squamous cell carcinoma without infiltration of the hepatic parenchyma. The patient underwent adjuvant chemotherapy. The patient did not have the common symptoms of gallbladder cancer. Then radiology was necessary to make a diagnosis. Surgery is the best therapeutic option for early-stage gallbladder cancer, but adjuvant chemo-radiation may also be useful in treating these patients. Cholecystectomy with resection of cystic dilatation of the bile duct in high-risk patients are the most effective means of prevention.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/terapia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Quimioterapia Adjuvante , Colecistectomia/métodos , Ducto Colédoco/patologia , Ducto Colédoco/cirurgia , Ducto Cístico/patologia , Ducto Cístico/cirurgia , Feminino , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/terapia , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pancreatectomia/métodos , Esplenectomia/métodos
3.
Pan Afr Med J ; 38: 89, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33889255

RESUMO

Introduction: although non-operative management of patients with blunt trauma to abdominal solid organs has become standard care, the role of peripheral hospitals remains poorly defined. This study reviews treatment and outcomes in patients with liver and spleen injuries at a regional hospital over a 10-year period. Methods: a retrospective review of prospectively collected data was performed and supplemented by case notes retrieval. All patients with solid visceral injuries managed between 2009 and 2019 at a rural surgical hospital in Zambia were included. On admission, the patients were offered either urgent laparotomy or non-operative management (NOM) depending on their haemodynamic status. Continuous variables were expressed as median and mean ± standard deviation; categorical data were expressed as percentages. Statistical evaluation of data was performed by two-sample t-test. Statistical significance was assigned at p<0.05. Results: fourty-three patients were included. The majority of victims sustained isolated spleen or liver injury. Twenty-three patients were urgently operated due to haemodynamic instability. Splenectomy performed in 17 patients, liver laceration sutured in 5 patients. One patient underwent concomitant splenectomy and liver repair. Conservative management was attempted in 20 (47%) patients and was successful in 18 (42%). In two patients NOM failed and splenectomy was performed urgently. Two patients died postoperatively. There were no deaths in NOM group. Conclusion: NOM of patients with injury to solid abdominal organs could be safely initiated in rural hospitals provided there is uninterrupted monitoring of patients' condition, well-trained staff and unrestricted access to the operating theatre (OT).


Assuntos
Traumatismos Abdominais/terapia , Fígado/lesões , Baço/lesões , Ferimentos não Penetrantes/terapia , Traumatismos Abdominais/fisiopatologia , Adolescente , Adulto , Idoso , Criança , Tratamento Conservador/métodos , Feminino , Hospitais Rurais , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esplenectomia , Índices de Gravidade do Trauma , Ferimentos não Penetrantes/fisiopatologia , Adulto Jovem , Zâmbia
4.
Rev Soc Bras Med Trop ; 54: e0748-2020, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33759927

RESUMO

Visceral leishmaniasis (VL) is an infectious disease caused by Leishmania spp. The recurrence of the disease occurs, in general, in patients with decreased or loss of T-cell function, whether due to the use of corticosteroids, immunosuppressive disease, or another cause. In some cases, splenectomy may be a therapeutic option. However, the effectiveness of splenectomy is not well defined. This report describes the evolution of a pediatric patient with seven recurrences of VL, who relapsed post-surgery after drug therapy and splenectomy.


Assuntos
Leishmania , Leishmaniose Visceral , Criança , Humanos , Leishmaniose Visceral/tratamento farmacológico , Recidiva , Esplenectomia
5.
Ann R Coll Surg Engl ; 103(4): e127-e130, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33682463

RESUMO

A wandering spleen is a very rare event characterised by the absence of the spleen in its anatomical position due to the hyperlaxity of its ligaments. We present a case of wandering spleen complicated by splenic vascular pedicle torsion, thrombosis and subsequent splenic infarction. Compression of the infarcted spleen on the rectosigmoid junction led to the development of a sigmoid volvulus, which presented as an acute large bowel obstruction. The patient underwent emergency laparotomy, splenectomy, sigmoid decompression and sigmoidopexy. After a follow-up period of two years, the volvulus had not recurred.


Assuntos
Obstrução Intestinal/etiologia , Volvo Intestinal/etiologia , Doenças do Colo Sigmoide/etiologia , Infarto do Baço/diagnóstico , Baço Flutuante/diagnóstico , Doença Aguda , Feminino , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Volvo Intestinal/diagnóstico , Volvo Intestinal/cirurgia , Pessoa de Meia-Idade , Doenças do Colo Sigmoide/diagnóstico , Doenças do Colo Sigmoide/cirurgia , Esplenectomia , Infarto do Baço/complicações , Infarto do Baço/cirurgia , Baço Flutuante/complicações , Baço Flutuante/cirurgia
6.
Ann R Coll Surg Engl ; 103(4): e131-e135, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33682478

RESUMO

Fungal infections are generally observed in immunosuppressed patients only, with a diagnostic challenge due to non-specific symptoms. For this reason, appropriate management may be delayed. This case report concerns a 36-year-old man with history of pancreas and kidney transplantation. He had chemotherapy for post-transplant B-cell lymphoma and presented with left upper abdominal pain and fever. Multiple investigations led to a final diagnosis of disseminated abdominal mucormycosis with multiple Rhizomucor abscesses in the liver, spleen and kidney transplant. Treatment was antifungal therapy and laparotomy with splenectomy, wedge resection of two fungal abscesses in segments II and IVb, and segmental left colic resection.


Assuntos
Abscesso Abdominal/diagnóstico , Transplante de Rim , Mucormicose/diagnóstico , Transplante de Pâncreas , Complicações Pós-Operatórias/diagnóstico , Rhizomucor/isolamento & purificação , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Adulto , Hepatectomia , Humanos , Hepatopatias/diagnóstico , Hepatopatias/etiologia , Hepatopatias/cirurgia , Masculino , Mucormicose/etiologia , Mucormicose/cirurgia , Complicações Pós-Operatórias/cirurgia , Esplenectomia , Esplenopatias/diagnóstico , Esplenopatias/etiologia , Esplenopatias/cirurgia
7.
Adv Ther ; 38(4): 1904-1930, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33687650

RESUMO

INTRODUCTION: Splenectomy and splenic artery embolization are major treatment options for hypersplenism and portal hypertension in liver cirrhosis, but may lead to splanchnic vein thrombosis (SVT), which is potentially lethal. We conducted a systematic review and meta-analysis to explore the incidence of SVT in liver cirrhosis after splenectomy or splenic artery embolization and the risk factors for SVT. METHODS: All relevant studies were searched through the PubMed, EMBASE, and Cochrane Library databases. The incidence of SVT in liver cirrhosis after splenectomy or splenic artery embolization was pooled. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS: Sixty-six studies with 5632 patients with cirrhosis were included. The pooled incidence of SVT after splenectomy and splenic artery embolization was 24.6% (95% CI 20.2-29.3%) and 11.7% (95% CI 7.1-17.3%), respectively. A meta-analysis of three comparative studies demonstrated that the incidence of SVT after splenectomy was statistically similar to that after splenic artery embolization (OR 3.15, P = 0.290). Platelet count, mean platelet volume, preoperative splenic or portal vein diameter, preoperative or postoperative portal blood velocity, splenic volume and weight, and periesophagogastric devascularization were significant risk factors for SVT after splenectomy. Postoperative use of preventive antithrombotic therapy was a significant protective factor against SVT after splenectomy. CONCLUSIONS: SVT is common in liver cirrhosis after splenectomy and splenic artery embolization. Coagulation and hemostasis factors, anatomical factors, and surgery-related factors have been widely identified for the assessment of high risk of SVT after splenectomy. Prophylactic strategy after splenectomy, such as antithrombotic therapy, might be considered in such high-risk patients. STUDY REGISTRATION: This study was registered in PROSPERO with a registration number of CRD42019129673.


Assuntos
Hipertensão Portal , Trombose Venosa , Humanos , Cirrose Hepática/complicações , Esplenectomia/efeitos adversos , Artéria Esplênica , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia
8.
Medicine (Baltimore) ; 100(13): e25308, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787621

RESUMO

ABSTRACT: Since its introduction in 1991, laparoscopic splenectomy (LS) has become the gold standard in elective spleen surgery in many centres. However, there still lack the report of long-term outcomes of LS with the large-scale cases. The aim of the present study was to analyze the short- and long-term outcomes of LS in a single institution over 16 years, and to compare the perioperative outcomes of totally laparoscopic splenectomy (TLS) and hand-assisted laparoscopic splenectomy (HALS) for splenomegaly.Between November 2002 and December 2018, 486 consecutive patients undergoing elective LS were enrolled in this study, including 222 TLS and 264 HALS. The intraoperative, postoperative, and follow-up data were retrospectively analyzed.The 5 most common indications were hypersplenism (71.0%), immune thrombocytopenia (14.8%), splenic benign tumor (4.5%), splenic cyst (2.9%), and splenic malignant tumor (2.9%). The mean operative time, intraoperative blood loss, and length of stay were 149.4 ±â€Š63.3 minutes, 230.1 ±â€Š225.1 mL, and 6.7 ±â€Š3.2 days, respectively. The morbidity, mortality, reoperation, and conversion rate were 23.0%, 0, 0.4%, and 1.9%, respectively. Portal vein system thrombosis (PVST) was the most frequent complication with an incidence of 19.8%. The incidence of PVST in HALS was higher than that in TLS (23.9% vs 14.9%, P = .013). Compared with TLS, HALS had a shorter operative time (P = .000), lower intraoperative blood loss (P = .000), comparable conversion rate (P = .271), and morbidity (P = .922) for splenomegaly > 17.0 cm. During the follow-up period, the overall respond rate for immune thrombocytopenia was 77.8%, and the esophagogastric variceal bleeding rate was 6.9% in 320 patients with hypersplenism secondary to hepatic cirrhosis.LS is a safe, feasible, and effective procedure with satisfactory short- and long-term outcomes. HALS is a reasonable technique in patients with massive spleens.


Assuntos
Laparoscopia Assistida com a Mão/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Esplenectomia/estatística & dados numéricos , Esplenopatias/cirurgia , Adolescente , Adulto , Idoso , Perda Sanguínea Cirúrgica , Criança , Estudos de Viabilidade , Feminino , Laparoscopia Assistida com a Mão/métodos , Humanos , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Esplenectomia/métodos , Resultado do Tratamento , Adulto Jovem
9.
Praxis (Bern 1994) ; 110(3): 143-144, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-33653103

RESUMO

CME Sonography 96/Answers: Spleen Changes Abstract. The spleen is a somewhat neglected organ but there are some changes that must not be neglected. Splenomegaly, caused worldwide most commonly by malaria, can occur in other infections, in portal vein thrombosis or in portal hypertension in the context of liver cirrhosis. An accessory spleen is also often found. Sometimes after splenectomy, small remains are found which may later hypertrophy. Where focal changes are concerned, we differentiate between various forms of spleen cysts, lymphomas, metastases, and benign tumors.


Assuntos
Hipertensão Portal , Baço , Humanos , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/patologia , Cirrose Hepática , Baço/diagnóstico por imagem , Baço/patologia , Esplenectomia , Esplenomegalia/diagnóstico por imagem , Ultrassonografia
11.
Medicine (Baltimore) ; 100(4): e24326, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530224

RESUMO

ABSTRACT: The spleen plays an important role in tumor progression and the curative effects of splenectomy before hepatectomy for hypersplenism and hepatocellular carcinoma (HCC) are not clear. We investigated whether splenectomy before hepatectomy increases survival rate among patients with HCC and hypersplenism compared with that of patients who underwent synchronous hepatectomy and splenectomy or hepatectomy alone.Between January 2011 and December 2016, 266 patients who underwent hepatectomy as a result of HCC and portal hypertension secondary to hepatitis were retrospectively analyzed. Their perioperative complications and survival outcome were evaluated.Patients underwent synchronous hepatectomy and splenectomy (H-S group) and underwent splenectomy before hepatectomy (H-preS group) exhibited significantly higher disease-free survival (DFS) rates than those of patients underwent hepatectomy alone (H-O group). The DFS rates for patients in the H-S group, H-preS group, and H-O group were 74.6%, 48.4%, 39.8%, and 80.1%, 54.2%, 40.1%, and 60.5%, 30.3%, 13.3%, at 1, 3, and 5 years after surgery, respectively. Tumor size, tumors number, and levels of alpha fetoprotein (AFP) were independent risk factors for DFS. Gender and tumor size were independent prognostic factor for overall survival (OS). The preoperative white blood cell (WBC) and platelet (PLT) counts were significantly higher in the H-preS group than in those of the H-S group and the H-O group. After operation, the WBC and PLT counts in the H-S group and H-preS groups were significantly higher compared to those of the H-O group.No matter splenectomy before hepatectomy or synchronous hepatectomy and splenectomy, hepatectomy with splenectomy may improve DFS rates in patients with HCC and hypersplenism, and splenectomy before hepatectomy alleviates hypersplenism without an increased surgical risk.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/mortalidade , Hiperesplenismo/cirurgia , Neoplasias Hepáticas/cirurgia , Esplenectomia/mortalidade , Adulto , Biomarcadores/sangue , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/mortalidade , Terapia Combinada , Intervalo Livre de Doença , Feminino , Hepatectomia/métodos , Humanos , Hiperesplenismo/complicações , Hiperesplenismo/mortalidade , Contagem de Leucócitos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Prognóstico , Estudos Retrospectivos , Esplenectomia/métodos , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , alfa-Fetoproteínas/análise
12.
Medicine (Baltimore) ; 100(4): e24436, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530246

RESUMO

BACKGROUND: The purpose of this study is to compare the clinical efficacy of laparoscopic splenectomy (LS) and open splenectomy (OS) in the treatment of Idiopathic thrombocytopenic purpura. METHODS: We systematically searched PubMed, Web of science, EMBASE, Clinicaltrials.gov, and Cochrane Central Register for studies (study published from July 1992-January 2020). This study analyzed the clinical effect of LS and OS on idiopathic thrombocytopenic purpur. RESULTS: This study showed that compared with OS, the LS's Overall response (OR: 0.60, 95% confidence interval (CI): 0.23-1.59, P = .30), Complication (OR: 0.59, 95% CI: 0.18-1.94, P = .38), Accessory spleen(OR: 1.70, 95% CI: 0.98-2.98, P = .06), Wound infections (OR: 0.65, 95% CI: 0.26-1.59, P = .34), Pancreatic fistula (OR: 0.73, 95% CI: 0.16-3.30, P = .68), was no significant, the Operative time (weighted mean difference (WMD): 49.33, 95% CI: 36.29-62.37, P < .00001)was longer, and the Estimated blood loss (WMD: -172.59, 95% CI: -319.96 to -25.22, P = .02), Postoperative length of stay (WMD: -4.68, 95% CI: -7.75 to -1.62, P = .003)was less. CONCLUSIONS: The therapeutic effect of LS was the same as that of OS in Overall response Complication Accessory spleen, while The operative time was longer, the Estimated blood loss was less, and the postoperative length of stay was shorter.


Assuntos
Laparoscopia/métodos , Púrpura Trombocitopênica Idiopática/cirurgia , Esplenectomia/métodos , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Resultado do Tratamento
13.
Acta Cir Bras ; 36(2): e360201, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33624718

RESUMO

PURPOSE: The spleen is relevant in blood purification, hematopoiesis, metabolism, and immune response to antigens, in addition to the storage and control on the release of metals and amino acids. Its functions concerning reproduction characteristics are still unknown. The objective was to study the influence of splenectomies on reproduction. METHODS: This study analyzed 25 mice couples, distributed into five groups: group 1 - control, no surgery: group 2 - control, submitted to laparotomy and laparorrhaphy only; group 3 - splenectomy in male mice; group 4 - splenectomy in female mice; group 5 - splenectomy in male and female mice. The animals were studied as regards the number of gestations and offspring generated in each gestation. RESULTS: A decrease in both the number of gestations and the number of offspring was verified in the male mice that had received a splenectomy when coupled with normal female mice. It is important to emphasize lower reproduction level when paired asplenic males with normal females, otherwise, the couples in which both mice had been splenectomized did not present change in the reproduction pattern. CONCLUSIONS: A reduction in the number of pregnancies and litters occurs in mice couples when the male mice were previously splenectomized.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Esplenectomia , Animais , Feminino , Masculino , Camundongos , Gravidez , Baço
14.
Acta Cir Bras ; 36(2): e360205, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33624722

RESUMO

PURPOSE: To evaluate the influence of autonomic vagal and splenic activities on renal histomorphometric aspects in obese rats. METHODS: Thirty male Wistar rats were used, of which, 24 received subcutaneous injections of monosodium glutamate (MSG) during the first 5 days of life (4 g/kg body weight) and six control animals received injections of saline solution (CON). Five experimental groups were organized (n = 6/group): falsely-operated control (CON-FO); falsely-operated obese (MSG-FO); vagotomized obese (MSG-VAG); splenectomized obese (MSG-SPL); vagotomized and splenectomized obese (MSG-VAG-SPL). RESULTS: The MSG-FO group animals showed a significant reduction in body weight and nasal-anal length when compared to CON-FO group animals (p < 0.05). The MSG-VAG-SPL group showed significant reduced in most biometric parameters associated with obesity. Falsely-operated obese animals showed a significant reduction in renal weight, glomerular diameters, glomerular tuff and capsule areas and Bowman's space compared to CON-FO group animals (p < 0.05). There was a significant reduction in diameter, glomerular tuft and capsule areas, and Bowman's space in MSG-VAG, MSG-SPL, MSG-VAG-SPL groups when compared to the MSG-FO group. CONCLUSIONS: Vagotomy associated with splenectomy induces a reduction in the adiposity and causes histological changes in the kidney of obese rats.


Assuntos
Esplenectomia , Vagotomia , Animais , Rim , Lipídeos , Masculino , Obesidade , Ratos , Ratos Wistar
15.
Acta Gastroenterol Belg ; 84(1): 51-56, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33639693

RESUMO

Background and study aims: To investigate the safety and efficacy of splenectomy for hepatolenticular degeneration (HLD) patients with PLT less than 20 × 109/L. Patients and methods: A total of 244 HLD patients with hypersplenism underwent splenectomy. According to the preoperative PLT values, the patients were divided into three groups : group A of 53 patients with PLT < 20 × 109/L ; group B of 92 patients with 20 × 109/L ≤ PLT ≤ 30 × 109/L ; group C of 99 patients with PLT > 30 × 109/L. General information including : blood cell counts, liver function , coagulation function 1 day before sugery and 1, 7, 14 days after surgery ; intraoperative blood loss ; operation time ; vital signs at the beginning, at 60 minutes and the end of the operation. Pressure and blood oxygen ; postoperative drainage ; postoperative complications and mortality. Results: Blood cell counts, liver function, and coagulation function were improved after splenectomy in three groups (P<0.05) ; there was no significant difference in blood loss, operation time, vital signs during the operation, postoperative drainage, postoperative complications and mortality between three groups (P>0.05). Conclusion: For HLD patients with hypersplenism, it is safe and effective to conduct splenectomy under PLT < 20 × 109/L.


Assuntos
Degeneração Hepatolenticular , Hiperesplenismo , Laparoscopia , Humanos , Hiperesplenismo/etiologia , Hiperesplenismo/cirurgia , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Esplenectomia , Resultado do Tratamento
16.
BMC Surg ; 21(1): 78, 2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33568109

RESUMO

BACKGROUND: The radical antegrade modular pancreatosplenectomy (RAMPS) which is a reasonable surgical approach for left-sided pancreatic cancer is emphasis on the complete resection of regional lymph nodes and tumor-free margin resection. Laparoscopic radical antegrade modular pancreatosplenectomy (LRAMPS) has been rarely performed, with only 49 cases indexed on PubMed. In this study, we present our experience of LRAMPS. METHODS: From December 2018 to February 2020, 10 patients underwent LRAMPS for pancreatic cancer at our department. The data of the patient demographics, intraoperative variables, postoperative hospital stay, morbidity, mortality, pathologic findings and follow-up were collected. RESULTS: LRAMPS was performed successfully in all the patients. The median operative time was 235 min (range 212-270 min), with an EBL of 120 ml (range 100-200 ml). Postoperative complications occurred in 5 (50.0%) patients. Three patients developed a grade B pancreatic fistula. There was no postoperative 30-day mortality and reoperation. The median postoperative hospital stay was 14 days (range 9-24 days).The median count of retrieved lymph nodes was 15 (range 13-21), and four patients (40%) had malignant-positive lymph nodes. All cases achieved a negative tangential margin and R0 resection. Median follow-up time was 11 months (range 3-14 m). Two patients developed disease recurrence (pancreatic bed recurrence and liver metastasis) 9 months, 10 months after surgery, respectively. Others survived without tumor recurrence or metastasis. CONCLUSIONS: LRAMPS is technically safe and feasible procedure in well-selected patients with pancreatic cancer in the distal pancreas. The oncologically outcomes need to be further validated based on additional large-volume studies.


Assuntos
Laparoscopia , Pancreatectomia , Neoplasias Pancreáticas , Esplenectomia , Humanos , Recidiva Local de Neoplasia , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Estudos Retrospectivos , Esplenectomia/métodos , Resultado do Tratamento
17.
Ann Hematol ; 100(4): 941-952, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33560468

RESUMO

Splenectomy is one of the treatments of immune thrombocytopenia (ITP) with a high response rate. However, it is an irreversible procedure that can be associated with morbidity in this setting. Our aim was to study the trends of splenectomy in adults with ITP, and the factors associated with splenectomy and resource utilization during these hospitalizations. We used the National (Nationwide) Inpatient Sample (NIS) to identify hospitalizations for adult patients with a principal diagnosis of ITP between 2007 and 2017. The primary outcome was the splenectomy trend. Secondary outcomes were (1) incidence of ITP trend, (2) in-hospital mortality, length of stay, and total hospitalization costs after splenectomy trend, and (3) independent predictors of splenectomy, length of stay, and total hospitalization costs. A total of 36,141 hospitalizations for ITP were included in the study. The splenectomy rate declined over time (16% in 2007 to 8% in 2017, trend p < 0.01) and so did the in-hospital mortality after splenectomy. Of the independent predictors of splenectomy, the strongest was elective admissions (adjusted odds ratio [aOR]: 22.1, 95% confidence interval [CI]:17.8-27.3, P < 0.01), while recent hospitalization year, older age, and Black (compared to Caucasian) race were associated with lower odds of splenectomy. Splenectomy tends to occur during elective admissions in urban medical centers for patients with private insurance. Despite a stable ITP hospitalization rate over the past decade and despite listing splenectomy as a second-line option for management of ITP in major guidelines, splenectomy rates consistently declined over time.


Assuntos
Púrpura Trombocitopênica Idiopática/cirurgia , Esplenectomia , Adulto , Fatores Etários , Procedimentos Cirúrgicos Eletivos , Seguimentos , Número de Leitos em Hospital , Custos Hospitalares , Mortalidade Hospitalar , Hospitalização , Hospitais de Ensino/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Renda , Tempo de Internação/estatística & dados numéricos , Utilização de Procedimentos e Técnicas , Púrpura Trombocitopênica Idiopática/economia , Estudos Retrospectivos , Esplenectomia/economia , Esplenectomia/métodos , Esplenectomia/estatística & dados numéricos , Esplenectomia/tendências , Resultado do Tratamento , Estados Unidos
18.
Praxis (Bern 1994) ; 110(2): 65-74, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33530784

RESUMO

CME Sonography 96: Spleen Changes Abstract. The spleen is a somewhat neglected organ but there are some changes that must not be neglected. Splenomegaly, caused worldwide most commonly by malaria, can occur in other infections, in portal vein thrombosis or in portal hypertension in the context of liver cirrhosis. An accessory spleen is also often found. Sometimes after splenectomy, small remains are found which may later hypertrophy. Where focal changes are concerned, we differentiate between various forms of spleen cysts, lymphomas, metastases, and benign tumors.


Assuntos
Hipertensão Portal , Baço , Humanos , Hipertensão Portal/patologia , Cirrose Hepática , Baço/diagnóstico por imagem , Baço/patologia , Esplenectomia , Esplenomegalia/diagnóstico por imagem
19.
BMC Surg ; 21(1): 46, 2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472623

RESUMO

BACKGROUND: This study aims to describe the clinical features of the isolated primitive splenic hydatid cyst, discuss and compare the different surgical approaches of this uncommon disease. METHODS: This is a descriptive retrospective study carried out over a period of 7 years extending from January 2013 to December 2019 reporting eight cases of isolated primitive splenic hydatid cysts. Data were collected from the register of the general surgery department of the Jendouba regional hospital. Files concerning another associated hydatid localization were excluded. Four patients underwent total splenectomy and four of them underwent different spleen preserving surgical techniques including resection of the protruding dome, partial splenectomy and pericystectomy. RESULTS: The diagnosis was incidentally made in 50% of cases. The main other revealing complaints are pain in the left upper quadrant of abdomen in 25% of cases and a painless renitent mass in the same quadrant in only 12,5%. None of patients who underwent total splenectomy had fever or sings of postoperative sepsis. Compared to those who had total splenectomy, patients who underwent spleen preserving surgery had a longer average hospital stay (9 vs 6,25 days) related to post-operative complications including abscess in the residual cavity after protruding dome resection in one patient and post-operative haemorrhage in one patient. CONCLUSIONS: The current case series argues in favor of total splenectomy, preferably by laparoscopic route whenever the technical platform allows it, associated with some specific peri-operative therapeutic measures. It seems to be the safest way that helps to avoid post-operative complications of spleen saving surgical modalities. These complications are usually difficult to manage in poor countries with limited technical resources. Total splenectomy guarantees at least a decreased hospital stay, reduced healthcare costs, and the absence of recurrence in highly endemic underdeveloped countries.


Assuntos
Equinococose/cirurgia , Esplenectomia/efeitos adversos , Adolescente , Adulto , Ensaio de Imunoadsorção Enzimática , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
Ulus Travma Acil Cerrahi Derg ; 27(1): 154-156, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394461

RESUMO

Wandering spleen is defined as the spleen that is not in its normal anatomic position due to the absence or laxity of suspensory ligaments. Congenital and acquired factors play a role in its etiology. It is a rare condition and may cause life-threatening complications as torsion or infarction. Rarely, patients may present to the emergency department with an acute abdomen. They may also present with chronic abdominal pain or intraabdominal mass. Given that its clinical diagnosis is difficult to make, radiological studies have an important role for an accurate diagnosis. In this paper, we presented a 24-year-old patient with torsion of a wandering spleen who presented with an acute abdomen and underwent laparoscopic splenectomy under urgent conditions.


Assuntos
Abdome Agudo , Anormalidade Torcional , Baço Flutuante , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Adulto , Humanos , Laparoscopia , Baço/diagnóstico por imagem , Baço/patologia , Esplenectomia , Anormalidade Torcional/complicações , Anormalidade Torcional/diagnóstico , Baço Flutuante/complicações , Baço Flutuante/diagnóstico , Adulto Jovem
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