Læknablaðið - 15.11.1998, Blaðsíða 15

LÆKNABLAÐIÐ 1998; 84
833
Valmiltistökur á Landspítalanum
1985-1994
Skúli Gunnlaugsson1’, Guðmundur M. Jóhannesson21, Jónas Magnússon1'3’
Gunnlaugsson S, Jóhannesson GM, Magnússon J
Elective splenectomies in Landspítalinn
1985-1994
Læknablaðið 1998; 84: 833-7
Objective: Splenectomy following trauma is well
known and the consequences have been investigated
thoroughly. Several splenic diseases are treated by
simple splenectomy. Furthermore, it may be neces-
sary to do a splenectomy in case of intraoperative
splenic trauma. The aim of this study was to investi-
gate the indications for splenectomy in these two
groups of patients and to estimate the longterm re-
sults.
Material and methods: We analysed all medical
files of patients without history of splenic trauma but
who nevertheless underwent splenectomy. We noted
clinical features, laboratory findings, complications
of the operation, volume of bloodloss and longterm
results regarding the primary diagnosis.
Results: In 1985-1994, 93 patients had splenectomy
at the former noted occasions. We found medical
files for 89 patients. Of them, 36 had disease of the
spleen or diseases associated with it (group A) but 53
had no splenic disease (group B). In group A, a great
variety of diseases led to splenectomies, idiopathic
thrombocytopenic purpura being in the ftrst place
(28%) and non Hodgkin's lymphoma in the second
place (12%). In group B the most common operation
was a gastrectomy due to gastric cancer (30%) but in
second place was an operation of the pancreas in
connection with pancreas cancer (13%). The most
common clinical indications for splenectomy in
group A were thrombocytopenia (34%) and abdomi-
Frá "handlækningadeild Landspítalans, 2|blóðfræöideild
Landspítalans, 3llæknadeild Háskóla íslands. Fyrirspurnir,
bréfaskipti: Jónas Magnússon, handlækningadeild Land-
spítalans. Sími: 560 1330, netfang: jonas@rsp.is
Lykilorð: miltistökur, blóðsjúkdómar, miltisstækkanir,
skuröáföll.
nal pain because of an enlarged spleen (23%). Intra-
operative trauma (49%) of the spleen was the most
common indication in group B. Before the operation,
13 patients got glucocorticoid steroids, nine patients
received blood transfusions, and six patients got
immunoglobulins, all in group A. There was less
bloodloss and therefore a lower need for tranfusions
in group A. Longterm results in group A, regarding
primary disease, were good in 24 patients (67%),
tolerable in three (8%), poor in four (11 %) but uncer-
tain in five (14%). Perioperative or postopertive
complications were minimal. Often the results of
splenectomies are good in patients with splenic dis-
eases and these operations are quite safe.
Conclusions: Longterm results are strongly connec-
ted with the underlying disease. With greater atten-
tion and care we suppose the incidence of splenec-
tomies could be lowered in patients without splenic
disease.
Key words: spienectomies, hematoiogicai diseases,
splenomegaly, perioperative complications.
Ágrip
Tilgangur: Miltistökur í kjölfar slysa eru vel
þekktar og afleiðingar þeirra vel rannsakaðar.
Ýmsir sjúkdómar sem tengjast milta eru lækn-
aðir með einfaldri miltistöku. Ennfremur getur
reynst nauðsynlegt að fjarlægja miltað vegna
aðstæðna og eins ef miltað laskast í aðgerð.
Markmið þessarar rannsóknar var að kanna
ábendingar miltistöku hjá þessunt tveimur hóp-
um auk þess að kanna langtímaárangur hjá
þeim fyrrnefnda.
Efniviður og aðferðir: Farið var yfir sjúkra-
skrár sjúklinga sem gengist höfðu undir miltis-
töku án undangenginnar áverkasögu á milta.
Auk ábendinga fyrir aðgerð voru skráð klínísk
einkenni, meðferð fyrir aðgerð, fylgikvillar að-
gerða, blóðtap og langtímaárangur metinn með
tilliti til upprunalegs sjúkdóms.
Niðurstöður: Á árunum 1985-1994 var
miltað fjarlægt vegna ofangreinds hjá 93 ein-
staklingum. Sjúkraskýrslur fundust fyrir 89