Physiological justification of organpreserving operations in spleen injuries
Aim. To study the parameters of microcirculation and the immune status of patients after splenectomy and organ-preserving surgery for spleen injuries in the late postoperative period. Methods. The indices of hemostasis and immune status were studied in 55 patients operated for splenic injuries: in 35 after splenectomy, in 20 - after organ-preserving surgery. The control group consisted of 30 practically healthy volunteers of similar age. The observation periods after surgery ranged from one to fifteen years. Results. Removal of the spleen leads to changes in coagulation link of the hemostasis system and manifests in the reduced blood plasma recalcification time, thrombin time. Simultaneously observed was the activation of the third phase of the process of blood coagulation. At the same time the activity of antithrombin III is reduced, fibrinolysis is inhibited. Such complications are not seen after the use of organ-preserving surgery. Changes in blood rheology in the late postoperative period were noted in 80% of the cases after splenectomy, and only in 0,8% - after organ-preserving surgery. Conclusions. Organ-preserving operations on the spleen do not cause changes in the immune status of patients, whereas splenectomy lead to the occurrence of abnormalities in the hemostatic system with the development of the chronic syndrome of disseminated intravascular coagulation