Objective To evaluate the safety and feasibility of splenectomy in adult hemophagocytic lymphohistiocytosis (HLH) of unknown origin. Methods The clinical data of 29 adults with HLH of unknown origin treated with splenectomy in our center from January 2013 to January 2017 were reviewed retrospectively. The patients with HLH were diagnosed with pathological examination of spleen postoperatively. Results All cases had repeated high fever, 27 cases (93.1%) with cytopenia involving at least two or three lineages, 23 cases(79.3%) with abnormal liver function and 24 cases (82.8%) with dysfunction of blood coagulation. American Society of Anesthesiologists (ASA) scores were above grade Ⅲ in all patients before operation. The maximum diameter of spleen was (22.8± 6.3) cm. The operative time was(112.3± 27.7) min and the estimated blood loss (281.8± 399.5) mL. The postoperative pancreatic leak occurred in 8 cases (27.6%) according to ISGPF definition, including 5 cases (17.2%) of grade A and 3 cases(10.3%) of grade B. Three cases (10.3%) had pulmonary infection. One case (3.5%) required relaparotomy due to postoperative abdominal bleeding. There was no peri-operative mortality in this study. After splenectomy, a clear lymphoma diagnosis could be determined in 27 patients (93.1%) and the cause of HLH in other 2 patients was still unclear. Conclusions Splenectomy is a valid and safe diagnostic approach for adult HLH of unknown origin even though the patients with HLH were in severe condition with multiple organ dysfunction of some patients. The pathological diagnosis for resected spleen provided a clue for the further treatment.
JIANG Chongyi, LIANG Yun, CAI Zhiwei, WANG Wei
. Anlaysis of safety of splenectomy in adult hemophagocytic lymphohistiocytosis[J]. Journal of Surgery Concepts & Practice, 2018
, 23(02)
: 135
-139
.
DOI: 10.16139/j.1007-9610.2018.02.011
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