镰状细胞病的部分脾切除术与全脾切除术：系统回顾与元分析》。

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2024-11-05 DOI:10.1016/j.jpedsurg.2024.162058

Merna Raafat Roshdy , Mina Botros , Abanoub Mokhles , Mohamed A. Aldemerdash , Haneen Sabet , Bishoy Fahim , Mahmoud Diaa Hindawi

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引用次数: 0

摘要

背景：镰状细胞病（SCD）患者会遇到各种并发症，如急性脾疝危机和脾功能亢进，可能需要进行脾切除术。本系统综述和荟萃分析旨在阐明全脾切除术（TS）或部分脾切除术（PS）在血液学和术后结果方面的差异：我们通过检索 PubMed、Web of Science、Scopus、Embase 和 Cochrane 数据库，确定了从开始到 2024 年 6 月涉及接受 PS 或 TS（开放式或腹腔镜）手术的 SCD 患者的研究，并对其血液学和手术结果进行了评估。主要结果：血红蛋白浓度和网织红细胞百分比。次要结果：手术输血需求、住院时间（LoS）、术后感染、严重脾切除术后败血症（OPSS）、急性胸部综合征（ACS）、血栓栓塞事件和死亡率：共纳入 18 项研究：17 项队列研究和 1 项病例系列研究。其中七项研究收集了来自同一家 SICHA 机构的数据，因此共纳入了 756 名 SCD 患者。根据最新研究，血红蛋白无明显变化（24 例 PS 患者术前 10.5 ± 0.3 vs 术后一年 9.6 ± 0.4，73 例 TS 患者术前 9.7 ± 0.1 vs 术后一年 9.7 ± 0.2），但 TS 和 PS 均使网织红细胞显著下降 2 %（0.8-3.2 %）。短期感染的比例分析表明，TS 的感染率为 2.71 %，PS 为 8.64 %；同样，ACS 的感染率也较低，TS 为 6.97 %，PS 为 14.90 %：这项首次系统回顾和荟萃分析表明，TS 和 PS 对血红蛋白没有影响或影响极小，但对网织红细胞百分比有很强的降低作用。比例分析显示，TS 比 PS 的短期感染和 ACS 更低。然而，要得出明确的结论并改进手术决策，还需要进一步的临床试验：研究类型：系统回顾和队列研究荟萃分析：证据等级：II。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Partial Splenectomy Versus Total Splenectomy in Sickle Cell Disease: A Systematic Review and Meta-Analysis

Background

Sickle cell disease (SCD) patients encounter various complications, such as acute splenic sequestration crisis and hypersplenism that may require splenectomy. This systematic review and meta-analysis aims to clarify differences between total splenectomy (TS) or partial splenectomy (PS) in terms of hematological and postoperative outcomes.

Methods

We identified studies involving SCD patients who underwent PS or TS, whether open or laparoscopic, and whose hematological and operative outcomes were evaluated, through searching PubMed, Web of Science, Scopus, Embase and Cochrane databases from inception until June 2024. Primary outcomes: hemoglobin concentration and reticulocytes %. Secondary outcomes: operative blood transfusion need, length of hospital stay (LoS), postoperative infections, overwhelming postsplenectomy sepsis (OPSS), acute chest syndrome (ACS), thromboembolic events and mortality.

Results

Eighteen studies were included; 17 cohort and one case series. Seven studies collected data from the same SICHA institutions, so a total of 756 SCD patients is included. According to the most recent study, no significant changes in hemoglobin (preoperative 10.5 ± 0.3 vs 9.6 ± 0.4 one year postoperative in 24 PS cases, and 9.7 ± 0.1 vs 9.7 ± 0.2 in 73 TS cases), however, both TS and PS significantly decreased reticulocyte by 2 % (0.8–3.2 %). Proportional analysis of short-term infection revealed a lower incidence in TS 2.71 % vs 8.64 % in PS, and similarly for ACS, it is 6.97 % in TS vs 14.90 % in PS.

Conclusion

This first systematic review and meta-analysis shows that TS and PS have no or minimal effect on hemoglobin but a strong lowering effect on reticulocyte %. Proportional analysis reveals lower short-term infections and ACS following TS than PS. However, further clinical trials are necessary to draw definite conclusions and improve surgical decision making.

Type of study

Systematic review and meta-analysis of cohort studies.

Level of evidence

II.

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.