摘要
目的探讨不明原因发热伴脾肿大行诊断性脾切除术的临床意义及可能的危险因素。方法回顾分析了我院20年来因不明原因发热、脾肿大行剖腹探查加诊断性脾切除术的54例患者的临床资料及病理检查结果，并对可能的危险因素进行分析。结果54例患者手术后经病理确诊39例，病理诊断率为72．2％（39／54），其中恶性淋巴瘤32例（59．3％，32／54）。25．9％的（14／54）患者出现手术并发症，并发症发生依次主要为：术后感染、出血、心功能衰竭、肝功能衰竭及膈下积液。9例（16．7％）患者围手术期死亡，死亡原因主要为：严重感染、术后出血、本身疾病恶化、心功能衰竭、肝功能衰竭及猝死。在相关危险因素中，有、无浆膜腔积液组死亡率分别为46．2％和7．5％（P=0．011）；脾脏重量≤500g,500—1500g及≥1500g组围手术期死亡率分别为0％、11．8％、50．0％（后2组比较，P=0．01）；有无黄疸、血三系减少、转氨酶升高及乳酸脱氢酶升高及病程长短与围手术期死亡率无明显相关（P〉0．1）。浆膜腔积液和巨脾是相对独立的影响死亡的因素（P值分别为0．011和0．01；／bY分别为20．4和18．6）。结论不明原因发热伴肝脾肿大患者，在高度怀疑恶性血液病但又不能明确诊断时，剖腹探查及诊断性脾切除术是有意义的方法。合并浆膜腔积液及巨脾者围手术期死亡率增高。
Objective To investigate the feasibility, safety, success rate of diagnosis and possible risk factors of splenectomy for fever of unknown origin （FUO） with splenomegaly. Methods The clinical data of 54 patients of FUO with splenomegaly who underwent splenectomy in Peking Union Medical College Hospital in the past 20 years were reviewed retrospectively. The diagnosis was not clear even after an extensive clinical evaluation before surgery. The pathologic findings, morbidity, mortality and possible risk factors were analyzed. ResultsPathological diagnosis was made in 39 of the 54 patients （72.2%）, including 29 cases of non-Hodgkin＇s lymphoma （NHL）, 4 cases of spleen tuberculosis, 3 cases of Hodgkin＇s lymphoma, 1 case of Castleman＇s disease, and 2 cases of hemophagocytic syndrome. Among the 15 cases for whom pathological examination failed to make an confirmed diagnosis were diagnosed as with NHL in 4 cases, Still＇s diseases in 4 cases, hypersplenism in 2 cases, and lymphoproliferative disease in 2 cases during the follow-up. Operation complications occurred in 25.9% of the patients and 16.7% （9/54） of the patients died within one month after surgery. The mortality of the patients with dropsy of serous cavity was 46.2%, significantly higher than that of the patients without dropsy of serous cavity （7.5%）. The mortality of the patients with a spleen heavier than 1500 g was 50.0%, significantly higher than that of the patients with a spleen lighter than 1500 g （ 11.8% ）. Complication of dropsy of serous cavity and splenomegaly were relatively independent death influencing factors （RR = 31.7 and 13.4 respectively, and P = 0. 004 and 0. 021 respectively）. There was no significant differences in the mortality rates of the patients with or without jaundice, pencytopenia, elevated SGPT, elevated LDH or duration of the disease （ all P 〉 0. 1 ）. Conclusion Splenectomy is an effective way for the diagnosis of FUO with splenomegaly. Patients with dropsy of serous cavity or a spleen heavier than 1500 g have higher mortality rates.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2006年第48期3385-3388,共4页
National Medical Journal of China
关键词
不明原因发热
脾大
脾切除术
诊断
Fever of unknown origin
Splenomegaly
Splenectomy
Diagnosis
