تعريف
Splenectomy is the surgical removal of the spleen. The spleen is an organ in the upper left part of the abdomen. It is beneath the ribs and behind the stomach. The spleen filters blood to remove bacteria, parasites, and other organisms that can cause infection. It also removes old and damaged blood cells.
أسباب هذا الإجراء
You may need to be treated by having a splenectomy if you have:
- Trauma to the spleen
- Spleen rupture due to tumor, infection, inflammatory condition, or medicines
- Enlargement of the spleen (splenomegaly)
- Certain blood disorders
- Myelofibrosis (abnormal formation of fibrous tissue in the نخاع العظم)
- Damage in the blood vessels of the spleen
- Leukemia or lymphoma
- Diseased spleen, due to disorders like HIV infection
- Tumor or abscess in the spleen
- مرض الكبد
المضاعفات المحتملة
If you are planning to have a splenectomy, your سيقوم الطبيب بمراجعة القائمة من المضاعفات المحتملة، والتي قد تشمل:
- العدوى
- نزيف
- Hernia formation at incision site
- Blood clots
- الأضرار التي لحقت الأجهزة الأخرى
تشمل العوامل التي قد تزيد من خطر حدوث مضاعفات ما يلي:
- السمنة
- التدخين
- سوء التغذية
- مرض مزمن أو حديث
- مرض السكري
- Old age
- أمراض القلب أو الرئة
- Bleeding or clotting disorders
ما يمكن توقعه
قبل الإجراء
قد يقوم طبيبك بما يلي:
- اختبار بدني
- اختبارات الدم والبول
- استعراض الأدوية
- X-rays of abdomen—a test that uses radiation to take a picture of structures inside the body
- CT scan—a type of x-ray that uses a computer to make pictures of the inside of the body
- Ultrasound—a test that uses sound waves to visualize the inside of the body
- Electrocardiogram (ECG, EKG)—a test that records the heart’s activity by measuring electrical currents through the heart muscle
- Other tests to evaluate spleen enlargement
- Studies to determine rate of destruction of red blood cells and/or platelets
- Give you vaccines against some infections (Without your spleen, you will be more susceptible to certain infections.)
التحدث مع طبيبك عن الأدوية الخاصة بك. قد يطلب منك التوقف عن تناول بعض الأدوية تصل إلى أسبوع واحد قبل العملية مثل:
- الأسبرين أو غيره من العقاقير المضادة للالتهابات
- سيولة الدم, مثل كلوبيدوجريل (بلافيكس) أو الوارفارين (الكومادين)
التخدير
General anesthesia will be used. You will be asleep.
الوصف الداخلي
The spleen can be removed through an open incision or through laparoscopic surgery.
Open Incision
An incision will be made in the abdomen over the spleen. The skin and muscles will be pulled back. The blood vessels to and around the spleen will be tied off. This will free the organ. Moist sponges may be placed in the abdomen. The sponges will absorb some of the blood and fluid. The spleen will be removed. If needed, further surgery may be done at this time to repair other organs. The sponges will then be removed.
The wound will be cleaned. The muscles and skin will be closed with stitches or staples. A gauze dressing will be placed over the wound.
Laparoscopic Removal
A small incision will be made in the abdomen. A laparoscope will be inserted through the incision. The laparoscope is a thin, lighted tube with a small camera on the end. It allows the doctor to see inside your body. Carbon dioxide gas will be passed into the abdomen. This inflates the abdomen and creates more room to work.
Two or three more small incisions will be made in the abdomen. Special tools will be inserted through these incisions. Blood vessels to the spleen will be cut and tied off. The spleen will then be rotated and removed. If the spleen has been ruptured, the abdomen is checked for any other injured organs or blood vessels. If needed, further surgery may be done at this time. The incisions will be closed with stitches and covered with surgical tape.
مباشرة بعد الإجراء
The removed spleen is sent to the lab for testing.
You will be taken to a recovery room and monitored. You may require a blood transfusion if you lost a lot of blood in the surgery.
كم من الوقت سيستغرق ؟
About 45-60 minutes
هل ستسبب الالم؟
Anesthesia prevents pain during the procedure. You may have pain from the incisions for a few days after surgery. If needed, your doctor can prescribe pain medicine to relieve this discomfort.
متوسط الإقامة في المستشفى
The usual length of stay is 2-4 days. Your doctor may choose to keep you longer if complications arise.
رعاية ما بعد العملية
It is important to follow your doctor’s instructions for postoperative care:
- اسأل طبيبك حول, عندما هي آمنة للاستحمام, السباحة, أو نقع في الماء.
- Replace any wet dressings with clean, dry ones.
- For minor pain, take only medicine that does not have aspirin.
- Avoid vigorous activity (exercise, heavy lifting, etc).
- Avoid driving for about six weeks, or as directed by your doctor.
- Make sure you get all the vaccines that your doctor recommends.
- تأكد من اتباع تعليمات طبيبك.
Recovery time may vary based on the extent of your injuries and any underlying disease or condition. On average, allow about 4-6 weeks for complete healing.
Always let your doctor(s) know that you do not have a spleen. Carry a national splenectomy card, which most hospital hematology departments can give you. When traveling, take special precautions against malaria and other infections.
استدعاء الطبيب
بعد مغادرة المستشفى ، اتصل بطبيبك في حالة حدوث أي مما يلي:
- علامات الإصابة, بما في ذلك حمى وقشعريرة
- احمرار أو تورم أو ألم متزايد أو نزيف مفرط أو إفرازات من موقع الشق
- سعال ، ضيق تنفس ، ألم في الصدر ، غثيان أو قيء شديد
- أعراض جديدة غير مبررة
في حالة الطوارئ ، اتصل على المساعدة الطبية على الفور.