5. 脾摘について

（本邦における現状とその解析）

抄録

The actual conditions and analytical results of splenectomy in the treatment of patients with chronic myelogenous leukemia (CML) in Japan were reported.
There were 58 splenectomized cases (including our ten cases) with CML until Aug. 1977 in Japan. Among them, 36 cases were still alive and 22 dead There was no cases over 60 years of age. Ninety percent of them were splenectomized after 1975, and these cases were splenectomized mainly as the treatment of this disease (prevention of blastic crisis).
All 58 cases were divided into three groups, that is chronic stage, accelerated stage and after blastic crisis.
Operative death occurred to only one case (1.7%) and it was due to bleeding from peptic ulcer. There was no problem during operation but occasionally we met with an unexpected bleeding like oozing.
Complications immediately after operation were bleeding and infection, but these were not severe. Generally speaking, splenectomy in CML was not dangerous at all. Thrombocytosis was an important problem as a long-term complication. Occasionally, there were attacks like transient ischemic attack (TIA) and these attacks were not prevented by platelet function inhibitory drugs.
As the effect of splenectomy, there was palliative effect that removes massive splenomegaly seen in the terminal stage and various discomfort due to splenomegaly. To evaluate whether splenectomy prolongs survival time or not, it is necessary to follow the patients more than three years.
From the results of this analysis, the indications for splenectomy in patients with CML might be summarized as follows;
(1) age under 60 years.
(2) within one year after definite diagnosis was made.
(3) hematologically well controlled cases in chronic stage.
(4) when adequate follow up could be assured.
(5) sufficient institutions and cooperation with skilled surgeons.