Overwhelming Post-Splenectomy Infection Clinical Trial
Official title:
Splenic Function After Spleen-Preserving Distal Pancreatectomy With Excision of Splenic Artery and Vein
The spleen may be removed due to benign hematologic disorders, such as idiopathic
thrombocytopenic purpura and hereditary spherocytosis, or malignancies, such as lymphomas
and leukemias. Splenectomy may also be performed due to splenic traumas or in association of
some surgical procedures, when combined splenectomy will make the operations easier. The
most well known procedure is distal pancreatectomy combined with splenectomy.
In this research, there are two main goals. Firstly, establish the data about the incidence
of overwhelming postsplenectomy infection (OPSI) in our country. Currently, the western data
of the incidence, morbidity rate and mortality rate of OPSI is well established and
vaccination along with prophylactic antibiotics is strongly recommended. Since the incidence
of OPSI in our country isn't clear, most (>95%) splenectomized patients in our hospital
(National Taiwan University Hospital) did not have vaccination or prophylactic antibiotics.
We'll try to determine the incidence of OPSI by reviewing of our hospital charts and by
structured interviews with patients.
The spleen is a phagocytic filter. So asplenic patients have higher risks of getting
infection and some spleen-preserving procedures are proposed. In our initial experiences,
distal pancreatectomy with splenic artery and vein divided could be safely performed and
greatly increased the possibility of preservation of spleen. However, when the spleen was
preserved with dividing the splenic artery and vein, the blood supply to the spleen will be
shifted from splenic artery to short gastric artery. Although a substantial immunologic
advantage exists if splenic tissue remains, this may not offer sufficient protection from
encapsulated bacteria if splenic arterial blood flow is reduced because experimental animal
studies have demonstrated that an intact splenic arterial system is necessary for optimal
control of infection. Thus, although the spleen is preserved in above mentioned procedure,
the function of the preserved spleen is questionable and has never been studied of. Our
second object is to determine the splenic function after after spleen-preserving distal
pancreatectomy with excision of splenic artery and vein by comparison of abdominal computed
tomography and immunological function of patients before and after operation. Besides, we'll
designed an animal experiment to examine the rate of pneumococcal clearance by the spleen
and to determine the relationship between splenic blood flow and splenic tissue mass in
bacterial clearance from the blood when the splenic vessels were divided.
n/a
Observational Model: Case-Only, Time Perspective: Retrospective