Splenectomy is a surgical procedure used to remove the spleen from the patient's body. The primary functions of the spleen include filtering blood, storing red blood cells, and participating in immune responses. When the spleen is damaged due to trauma, disease, or functional abnormalities that pose serious health risks, physicians evaluate whether to perform this surgery. This treatment effectively addresses symptoms caused by splenic rupture, hyperactivity, or specific hematological diseases, but requires weighing surgical risks against the patient's overall health status.
The surgical approach can be total or partial splenectomy, depending on the severity of the condition. Modern medical techniques often utilize minimally invasive laparoscopic surgery to reduce trauma and shorten recovery time. Postoperative follow-up is necessary because removal of the spleen may affect immune function, requiring special attention to infection prevention.
Splenectomy can be divided into "traditional open surgery" and "laparoscopic surgery." Laparoscopic surgery involves inserting instruments through several small incisions (0.5-1 cm) with a camera guiding the removal of splenic tissue, resulting in smaller wounds and quicker recovery. Total splenectomy is suitable for severe splenic injury or hematological diseases, while partial removal is used in specific cases where some splenic function needs to be preserved.
The mechanism involves directly removing diseased tissue. For example, when the spleen ruptures and bleeds due to trauma, removal can immediately stop bleeding; for blood diseases such as hypersplenism, removing the spleen can halt its excessive destruction of blood cells. Postoperative vaccination is necessary because the spleen is responsible for clearing pathogens from the blood; its removal increases infection risk.
Main indications include:
In certain blood disorders, the spleen may excessively destroy platelets or red blood cells, leading to abnormal blood cell counts. For example, excessive destruction of platelets can cause severe bleeding tendencies; splenectomy can immediately halt this phenomenon. However, patient age and overall health must be carefully evaluated, especially in elderly patients or those with other chronic conditions.
The surgery requires general anesthesia and lasts approximately 2-4 hours. Laparoscopic surgery involves making 3-4 small incisions (0.5-1 cm) in the abdomen to insert a camera and surgical instruments. The surgeon isolates and ligates the splenic artery and blood vessels before fragmenting and removing the spleen. Open surgery involves a 10-15 cm incision in the upper abdomen, suitable for severe splenic injury or extensive adhesions.
Postoperative hospitalization typically lasts 3-7 days, depending on the surgical method. Patients receive pain relief and antibiotics, along with deep breathing exercises to prevent pneumonia. During recovery, strenuous activity should be avoided; full activity usually resumes in 6-8 weeks. There is no "dosage" concept for the surgery, but the extent of removal should be adjusted based on the patient's body size.
Main benefits include:
Long-term benefits include reduced transfusion needs in blood disorder patients and symptom relief in autoimmune diseases. Regular monitoring of blood counts and immune status is necessary because splenectomy may affect resistance to certain pathogens.
Main risks include:
Long-term side effects include OPSI (Overwhelming Post-Splenectomy Infection) syndrome, which makes patients susceptible to pathogens like pneumococcus. Therefore, vaccination and lifelong antibiotics are recommended to prevent infections. Some patients may experience left upper abdominal spasms or temporary gastrointestinal dysfunction.
Contraindications include:
Postoperative care includes: lifelong vaccination (such as pneumococcal, Haemophilus influenzae type b vaccines), and regular blood count monitoring. The physician will decide on long-term low-dose aspirin therapy based on the patient's age and underlying conditions to prevent thrombosis.
Preoperative use of anticoagulants (e.g., warfarin) should be paused and replaced with low molecular weight heparin. Antibiotic use postoperatively should avoid interactions with immunosuppressants. Patients undergoing chemotherapy for hematological diseases may need dose adjustments to accommodate surgery timing.
Concurrent use of pain medications may delay wound healing; selecting gastrointestinal-friendly analgesics is advised. Patients on immunosuppressants like steroids should have dosage adjustments to prevent excessive immune suppression.
For traumatic splenic rupture, the success rate of immediate hemostasis exceeds 95%. In hematological treatments, patients with hereditary spherocytosis can experience complete resolution of hemolysis, with hemoglobin levels increasing by an average of 30-50%. Cases of hypersplenism caused by portal hypertension show platelet counts returning to normal ranges.
Long-term follow-up indicates that patients who undergo laparoscopic surgery have an average hospital stay shortened to 3-5 days, compared to 7-10 days for open surgery. Five-year follow-up data show a 20-30% improvement in overall survival rates in indicated patients compared to untreated groups.
Non-surgical treatments include:
Patients with portal hypertension may consider shunt procedures to lower portal pressure, though this can cause hepatic encephalopathy. Blood disorder patients may receive immunoglobulin injections or blood cell transfusions, but these are temporary measures.
Before splenectomy, patients typically undergo comprehensive examinations, including blood tests and imaging studies (such as abdominal ultrasound or CT scan), to assess spleen condition and surgical feasibility. Doctors may adjust anticoagulant medications and recommend pneumococcal and influenza vaccinations to reduce postoperative infection risks.
Will the risk of infection increase after splenectomy? How can it be prevented?After splenectomy, patients lose the spleen's immune function, increasing the risk of severe infections like sepsis. Physicians prescribe long-term antibiotics for prophylaxis and recommend annual vaccinations. Patients should also monitor for symptoms like fever or chills and seek immediate medical attention if abnormal signs occur.
How long after surgery can I return to normal activities?Recovery from open surgery typically takes 4-6 weeks, while laparoscopic surgery usually takes 2-4 weeks. During initial recovery, patients should avoid lifting heavy objects or strenuous activities, gradually resuming activities as advised by their doctor. Complications such as bleeding or infection may prolong recovery.
Is long-term anticoagulant therapy necessary after splenectomy?Some patients may experience increased platelet counts post-splenectomy, raising thrombosis risk, and doctors might recommend short-term or long-term low-dose anticoagulants. The specific medication regimen should be based on postoperative blood tests, and regular monitoring of thrombosis indicators is essential.
What should be monitored during long-term follow-up?Regular checks of blood counts, liver and kidney functions, and immune indicators are necessary to monitor for functional abnormalities. Patients should report any signs of infection or thrombosis, such as unexplained fever or limb swelling, and adhere to vaccination schedules.
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