脾脏是执行重要的血液学和免疫学功能的腹膜内器官。它保持先天和适应性免疫,并保护身体免受微生物感染。从1500年代早期开始将脾脏切除作为一种治疗方法,用于外伤,甚至在脾脏的生理学被正确理解之前。脾切除术在许多情况下都有治疗作用,如镰状细胞性贫血,地中海贫血,特发性血小板减少性紫癜(ITP),霍奇金病,和淋巴瘤。然而,它增加了感染的风险,在某些情况下,可能导致严重的败血症,称为压倒性的脾切除术后感染(OPSI),死亡率很高。封装的细菌构成了入侵生物的主要部分,其中最常见的是肺炎链球菌。OPSI是一种需要及时诊断的医疗紧急情况(具有血液培养和敏感性,血糖水平,肾功能试验,和电解质水平)和液体复苏以及立即使用经验性抗生素的管理。OPSI可以通过教育患者来预防,疫苗接种,和抗生素预防。本文总结了脾脏的解剖和生理学,并强调了其重要功能。它主要集中在OPSI的病理生理学,目前的管理,和预防策略。
The spleen is an intraperitoneal organ that performs vital hematological and immunological functions. It maintains both innate and adaptive immunity and protects the body from microbial infections. The removal of the spleen as a treatment method was initiated from the early 1500s for traumatic injuries, even before the physiology of spleen was properly understood. Splenectomy has therapeutic effects in many conditions such as sickle cell anemia, thalassemia, idiopathic thrombocytopenic purpura (ITP), Hodgkin\'s disease, and lymphoma. However, it increases the risk of infections and, in some cases, can lead to a case of severe sepsis known as overwhelming post-splenectomy infection (
OPSI), which has a very high mortality rate. Encapsulated bacteria form a major proportion of the invading organisms, of which the most common is Streptococcus pneumoniae.
OPSI is a medical emergency that requires prompt diagnosis (with blood cultures and sensitivity, blood glucose levels, renal function tests, and electrolyte levels) and management with fluid resuscitation along with immediate administration of empirical antimicrobials.
OPSI can be prevented by educating patients, vaccination, and antibiotic prophylaxis. This article summarizes the anatomy and physiology of the spleen and highlights its important functions. It primarily focuses on the pathophysiology of
OPSI, its current management, and prevention strategies.