Abstract：
Background: Splenectomy has been performed for various indications from haematological diseases to benign cysts and tumours, and for splenic traumatic injuries. However, there has been a steady decline in splenectomies in the last 20 years. The aim of this study is to establish the reasons behind this decline in splenectomy and to analyse them based on indication, type of splenectomy, and manner of approach (open, laparoscopic or robotic). Material and Methods: This is a retrospective study of a single centre experience of all the splenectomies, both total and partial, performed in the Department of General Surgery of Fundeni Clinical Institute (Bucharest) between 2002 and 2023. Only surgeries for primary splenic diseases were selected, splenic resections as part of other major operations were not included. Results: Between 2002 and 2023, 876 splenectomies were performed in the Department of General Surgery of Fundeni Clinical Institute (Bucharest). Most splenectomies (n=245) were performed for immune thrombocytopenic purpura (ITP), followed by benign tumours and cysts (n=136), lymphoma (n=119), hypersplenism due to cirrhosis (n=107) and microspherocytosis (n=95). Other indications included myelodysplastic syndrome (n=39), trauma (n=35), thalassemia (n=22), leukaemia (n=18) and also there were 60 splenectomies that were performed for hypersplenism of unknown cause. There were 795 total splenectomies (TS) and 81 partial splenectomies (PS). There was a decline in the number of splenectomies both TS and PS for all these indications, most notably in the case of ITP, microspherocytosis and hypersplenism due to cirrhosis with no splenectomies performed for these indications since 2020. Conclusion: With the development of new lines of treatment, advances in interventional radiology and in surgery with the spleen parenchyma sparing options, the need for total splenectomy has been greatly reduced which is reflected in the decline in the number of splenectomies performed in the last 20 years in our clinic.
摘要：
背景：脾切除术已被用于从血液病到良性囊肿和肿瘤的各种适应症，以及脾外伤.然而,在过去的20年里，脾切除术稳步下降。这项研究的目的是确定脾切除术下降的原因，并根据适应症进行分析。脾切除术的类型，和方法(开放，腹腔镜或机器人)。材料和方法：这是一项对所有脾切除术的单中心经验的回顾性研究，全部和部分，2002年至2023年在Fundeni临床研究所（布加勒斯特）的普外科进行。只选择原发性脾疾病的手术，不包括作为其他主要手术一部分的脾切除术.结果：在2002年至2023年之间，在Fundeni临床研究所（布加勒斯特）的普外科进行了876例脾切除术。大多数脾切除术（n=245）用于免疫性血小板减少性紫癜（ITP），其次是良性肿瘤和囊肿（n=136），淋巴瘤（n=119），肝硬化脾功能亢进（n=107）和微球体增多症（n=95）。其他适应症包括骨髓增生异常综合征（n=39），创伤（n=35），地中海贫血（n=22），白血病（n=18），还有60例因不明原因脾功能亢进而进行的脾切除术。总脾切除术（TS）795例，部分脾切除术（PS）81例。所有这些适应症的TS和PS脾切除术数量均有所下降，最值得注意的是在ITP的情况下，自2020年以来，未针对这些适应症进行脾切除术的肝硬化引起的微球体增多和脾功能亢进。结论:随着治疗新路线的发展,介入放射学和保留脾实质的手术的进展，全脾切除术的需求已大大减少，这反映在过去20年我们诊所进行脾切除术的数量减少。
