Surgical therapy of hematological disorders of spleen

Splenectomy - the surgical removal of spleen is being performed in cases of: traumatic spleen rupture, as part of other surgical procedures, number of hematological, infectious and metabolic disorders. During the years 1988-2001, there were 396 splenectomies performed at the First surgical clinic, for the cause of: autoimmune disorders 187 (47,34%), lymphoproliferative diseases 89 (22,59%), Hodgkin disease 35(8,94%), myeloproliferative disease 39 (9,95%), as part a of "staging" laparotomy 37 (9,34%), other hematological disorders 7 (2,20%). The spleen of 244 patients weighted 500-1500 g (61,62%), in 56 patients (14,14%) weighted less than 500g, and in 96 patients (24,24%) spleen weighted more than 1500 g . Patients with thrombocytes less than 40000/l 16 (4,04%) were perioperativly treated with fresh thrombocytes. Postoperative morbidity and mortality were registered in 54 (13,64%), i.e. 8 (2.02%) patients. Delayed results depended on primary disorder, comorbidities and supportive therapy. In this article, the particularities of the operative procedure were discussed, as well as importance of cooperation of surgeon and hematologist in perioperative treatment. Splenektomija se izvodi kod rupture slezine zbog traume, u sklopu drugih hirurskih intervencija, niza hematoloskih, infektivnih i metabolickih oboljenja. U periodu 1988-2001. god. na Prvoj hirurskoj klinici KCS u Beogradu izvrseno je 396 splenektomija zbog sledecih hematoloskih oboljenja: autoimuni poremecaji 187 (47,34%), limfoproliferativne bolesti 89 (22,59%), Hodgkinova bolest 35 (8,94%), mijeloproliferativne bolesti 39 (9,95%), u cilju "staging" laparotomije 37 (9,34%) i zbog ostalih hematoloskih poremecaja 7 (2,20%). Kod 244 bolesnika tezina slezine je iznosila 500-1500 gr. (61,62%), kod 56 (14,14%) je bila manja od 500 gr, a kod preostalih 96 (24,24%) je bila veca od 1500 gr. Bolesnici sa vrednostima trombocita manjim od 40 hiljada/l (16 - 4,04%) su perioperativno primali separatisanc trombocite. Postoperativni morbiditet i mortalitet je registrovan kod 54 (13,64%) odnosno 9 (2,27%) bolesnika. Udaljeni rezultati su zavisili pretezno od osnovnog oboljenja, pratecih oboljenja i dodatne terapije. U radu su istaknute specificnosti operativnog postupka, kao i znacaj saradnje hematologa i hirurga u perioperativnom lecenju .