切换至 "中华医学电子期刊资源库"

中华诊断学电子杂志 ›› 2016, Vol. 04 ›› Issue (04) : 236 -239. doi: 10.3877/cma.j.issn.2095-655X.2016.04.005

所属专题: 文献

肿瘤诊治研究

原发性骨髓纤维化伴巨脾患者脾切除术前后血常规动态观察
高建军1,(), 林楠1, 杨建栋1, 于鲜君1   
  1. 1. 116021 大连,解放军第210医院普通外科
  • 收稿日期:2016-05-29 出版日期:2016-11-26
  • 通信作者: 高建军
  • 基金资助:
    辽宁省科学技术计划项目(2015020412)

The impact of splenectomy on the blood routine examination in a patient with primary myelofibrosis and megalosplenia

Jianjun Gao1,(), Nan Lin1, Jiandong Yang1, Xianjun Yu1   

  1. 1. Department of General Surgery, 210 Hospital of Chinese People′s Liberation Army, Dalian 116021, China
  • Received:2016-05-29 Published:2016-11-26
  • Corresponding author: Jianjun Gao
  • About author:
    Corresponding author: Gao Jianjun, Email:
引用本文:

高建军, 林楠, 杨建栋, 于鲜君. 原发性骨髓纤维化伴巨脾患者脾切除术前后血常规动态观察[J]. 中华诊断学电子杂志, 2016, 04(04): 236-239.

Jianjun Gao, Nan Lin, Jiandong Yang, Xianjun Yu. The impact of splenectomy on the blood routine examination in a patient with primary myelofibrosis and megalosplenia[J]. Chinese Journal of Diagnostics(Electronic Edition), 2016, 04(04): 236-239.

目的

探讨原发性骨髓纤维化(PMF)伴巨脾患者脾切除术对血常规的影响。

方法

对1例PMF伴巨脾患者脾切除术前后的血常规等指标进行动态观察,并对切除的巨脾进行组织学检查。

结果

患者术后呼吸困难、腹胀、纳差等症状明显好转。血常规结果示:白细胞明显升高,中性粒细胞百分比下降,淋巴细胞百分比升高,红细胞数变化相对较小,血红蛋白术后早期由于自体脾血回输升高,继之基本平稳,血小板变化最显著,术后明显减少,第5天最低仅10×109/L,后逐渐恢复正常。组织学检查可见脾脏出现骨髓化倾向。

结论

PMF伴巨脾行脾切除后血常规改变明显,脾脏出现了部分代替骨髓造血的组织学改变,脾切除后机体血细胞计数逐渐恢复正常。对PMF伴脾脏巨大导致影响呼吸和消化功能的患者应予以切除脾脏。

Objective

To explore the impact of splenectomy on the blood routine examination in a patient with primary myelofibrosis (PMF) and megalosplenia.

Methods

Splenectomy was performed on a patient diagnosed with PMF and megalosplenia.Blood routine examinations were dynamically observed and histological examination was performed on the spleen.

Results

After splenectomy, the symptoms of dyspnea, abdominal distension and inappetence improved markedly.Leukocyte increased significantly.The percentage of neutrophils decreased while the percentage of lymphocytes increased.The change of erythrocyte was not obvious.Due to autologous blood transfusion, hemoglobin increased immediately after surgery, and then returned to normal level.Platelet fell to 10×109/L, and then increased gradually to normal level.Histological examination demonstrated that the spleen showed myeloid metaplasia.

Conclusions

Blood routine examination changes significantly after splenectomy is performed on the patient diagnosed with PMF and megalosplenia.The spleen shows certain bone marrow hematopoietic function.After splenectomy, the hematopoietic ability can still meet the need of the body.Thus, splenectomy should be performed on patients with injured respiratory and digestive function due to PMF-caused megalosplenia.

图1 骨髓纤维化伴巨脾患者术中脾脏外观图像。示脾脏大小约40 cm×20 cm×10 cm
图2 骨髓纤维化伴巨脾患者切除脾脏大体标本。示脾脏经自体脾血回输后萎缩变小,约33.8 cm×17.5 cm×8.3 cm
图3 骨髓纤维化伴巨脾患者腹部查体外观图像。示Ⅰ线(左锁骨中线与肋缘交点,至脾下缘)35 cm,Ⅱ线(左锁骨中线与肋缘交点至脾最远端)45 cm,脾右缘已越过前正中线8 cm(画线范围示巨脾)
图4 骨髓纤维化伴巨脾患者骨髓细胞学检查图像(HE ×400)。可见大量纤维组织(箭头所示)
图5 骨髓纤维化伴巨脾患者腹部CT图像。脾脏已进入盆腔(可见骶骨),脾周有积液(箭头所示)
表1 骨髓纤维化伴巨脾患者手术前后血常规变化情况
图6 骨髓纤维化伴巨脾患者脾脏组织病理学图像(HE ×400)。可见纤维组织增生(箭头所示)
[1]
Kröger N,Giorgino T,Scott BL, et al.Impact of allogeneic stem cell transplantation on survival of patients less than 65 years of age with primary myelofibrosis[J]. Blood, 2015, 125(21): 3347-3350.
[2]
Mohyuddin GR,Yacoub A. Primary myelofibrosis presenting as extramedullary hematopoiesis in a transplanted liver rraft:case report and review of the literature[J]. Case Rep Hematol, 2016: 9515404.
[3]
Maia RC,Bonamino MH,Robaina MC, et al.An unusual long-term outcome of a child with primary myelofibrosis harboring a JAK2 mutation[J]. Blood Cells Mol Dis, 2015, 55(4): 347-350.
[4]
Pistevou-Gombaki K,Zygogianni A,Kantzou I, et al.Splenic irradi ation as palliative treatment for symptomatic splenomegaly due to secondary myelofibrosis:a multi-institutional experience[J]. J BUON, 2015, 20(4): 1132-1136.
[5]
Webb M,Shibolet O,Halpern Z, et al.Assessment of liver and spleen stiffness in patients with myelofibrosis using fibroscan and shear wave elastography[J]. Ultrasound Q, 2015, 31(3): 166-169.
[6]
Ayl1 M,özcan M,Cengiz Seval G. Ruxolitinib treatment in a patient with primary myelofibrosis resistant to conventional therapies and splenectomy:a case report[J]. Turk J Haematol, 2015, 32(2): 180-183.
[7]
El Fakih R,Popat U. Janus Kinase Inhibitors and Stem Cell Trans plantation in Myelofibrosis[J]. Clin Lymphoma Myeloma Leuk, 2015(15): S34-S42.
[8]
Duenas-Perez AB,Mead AJ.Clinical potential of pacritinib in the treatment of myelofibrosis[J]. Ther Adv Hematol, 2015, 6(4): 186-201.
[9]
Wassie E,Finke C,Gangat N, et al.A compendium of cytogenetic abnormalities in myelofibrosis:molecular and phenotypic correlates in 826 patients[J]. Br J Haematol, 2015, 169(1): 71-76.
[10]
Kröger N. Current challenges in stem cell transplantation in myelofi brosis[J]. Curr Hematol Malig Rep, 2015, 10(4): 344-350.
[11]
Breccia M,Molica M,Colafigli G, et al.Improvement of bone marrow fibrosis with ruxolitinib:will this finding change our perception of the drug?[J]. Expert Rev Hematol, 2015, 8(4): 387-389.
[12]
Markiewicz M,Dzierzak Mietla M,Wieczorkiewicz A, et al.Safety and outcome of allogeneic stem cell transplantation in myelofibrosis[J]. Eur J Haematol, 2016, 96(3): 222-228.
[13]
Hasselbalch HC.Perspectives on the increased risk of second cancer in patients with essential thrombocythemia polycythemia vera and myelofibrosis[J]. Eur J Haematology, 2015, 94(2): 96-98.
[14]
Derlin T,Alchalby H,Bannas P, et al.Assessment of bone marrow inflammation in patients with myelofibrosis:an 18F-fluorodeoxyglucose PET/CT study[J]. Eur J Nucl Med Mol Imaging, 2015, 42(5): 696-705.
[15]
Lane SW,Mullally A. Hit the spleen, JAK![J]. Blood, 2014, 124(19): 2898-2900.
[16]
Jung CW,Shih LY,Xiao Z, et al.Efficacy and safety of ruxolitinib in Asian patients with myelofibrosis[J]. Leuk Lymphoma, 2015, 56(7): 2067-2074.
[17]
Santos FP,Verstovsek S. Efficacy of ruxolitinib for myelofibrosis[J]. Expert Opin Pharmacother, 2014, 15(10): 1465-1473.
[18]
Gabali AM,Jazaerly T,Chang CC, et al.Simultaneous hepatosplenic T-cell lymphoma and myelofibrosis[J]. Avicenna J Med, 2014, 4(2): 34-36.
[19]
Shimoda K,Takenaka K,Kitanaka A, et al.Clinical aspects of primary myelofibrosis in Japan[J]. Rinsho Ketsueki, 2014, 55(3): 289-294.
[20]
Mughal TI,Vaddi K,Sarlis NJ, et al.Myelofibrosis-associated com plications:pathogenesis, clinical manifestations, and effects on outcomes[J]. Int J Gen Med, 2014(7): 89-101.
[1] 李保启, 王佳佳, 王金萍, 伍宏兵. 肝豆状核变性患者脾切除术后门静脉系统血栓形成的危险因素分析[J]. 中华医学超声杂志(电子版), 2022, 19(08): 818-822.
[2] 张孔玺, 李小红, 李越洲, 商中华. 选择性脾动脉栓塞术与传统开腹手术治疗外伤性脾破裂安全性和有效性的Meta分析[J]. 中华普通外科学文献(电子版), 2022, 16(06): 452-460.
[3] 陈亚峰, 李江斌, 王栋, 臧莉, 鲁建国, 董瑞. 腹腔镜脾切除术在巨脾脾动脉栓塞后远期治疗中的应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 571-574.
[4] 耿志达, 俞星新, 刘雨, 梁英健. 脾切除术后门静脉血栓形成及其机制的研究进展[J]. 中华普外科手术学杂志(电子版), 2023, 17(01): 110-113.
[5] 张菊梅, 黄玉荣, 王迪迪, 李强, 吴霞, 杨杰. 腹腔镜脾切除术治疗肝硬化门静脉高压症中对脾蒂血管的不同处理方式比较[J]. 中华普外科手术学杂志(电子版), 2022, 16(06): 643-646.
[6] 索郎多杰, 巴桑顿珠, 高红桥, 仁桑. 腹腔镜脾部分切除术治疗儿童原发性脾囊性包虫病:病例报告及文献复习[J]. 中华普外科手术学杂志(电子版), 2022, 16(05): 589-590.
[7] 赵国栋. 机器人根治性顺行模块化胰脾切除术[J]. 中华普外科手术学杂志(电子版), 2022, 16(04): 368-368.
[8] 林文斌, 郑泽源, 郑文能, 郁毅刚. 外伤性脾破裂腹腔镜脾切除术患者中转开腹风险预测模型构建[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 619-623.
[9] 张其坤, 商福超, 李琪, 栗光明, 王孟龙. 联合脾切除对肝癌合并门静脉高压症患者根治性切除术后的生存获益分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 613-618.
[10] 许语阳, 吕云福, 王葆春. 乙肝后肝硬化门静脉高压症脾肿大外科治疗进展[J]. 中华肝脏外科手术学电子杂志, 2023, 12(04): 469-473.
[11] 陈亚峰, 李江斌, 王栋, 鲁建国, 董瑞. 脾动脉栓塞术后远期腹腔镜巨脾切除术一例[J]. 中华肝脏外科手术学电子杂志, 2023, 12(04): 454-456.
[12] 杨林青, 任松, 纪泛扑, 张健, 蒋安, 张丽, 安鹏, 王林, 李宗芳. 揿针疗法对门静脉高压症脾切除断流术后胃肠功能的调节作用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(03): 322-326.
[13] 李硕, 周金婵, 李宇, 王卫东. 腹腔镜脾部分切除术在脾脏良性占位性病变中的应用价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(01): 96-102.
[14] 王慧君, 卢俊杰, 郑卫华, 张俊晶. 脾脏疾病腹腔镜手术治疗现状及围手术期管理[J]. 中华肝脏外科手术学电子杂志, 2022, 11(06): 653-656.
[15] 张春, 林婷, 张靖垚, 刘司南, 苗润晨, 王铮, 刘昌. 急性胰腺炎合并区域性门静脉高压症诊治分析[J]. 中华肝脏外科手术学电子杂志, 2022, 11(01): 48-53.
阅读次数
全文


摘要