Akın ÖNDER, Murat KAPAN, Mesut GÜL, İbrahim ALİOSMANOĞLU, Zülfü ARIKANOĞLU, Fatih TAŞKESEN, İlhan TAŞ, Enver AY, Sadullah GİRGİN

Splenectomy in patients with idiopathic thrombocytopenic purpura: Analysis of 109 cases

Amaç: Splenektomi, medikal tedaviye dirençli ve şiddetli seyreden İdiopatik trombositopenik purpuralı hastalarda te-davi sağlamak amacıyla yapılmaktadır. Bu çalışmada İdiopatik trombositopenik purpura tanısıyla splenektomi uygu-lanan hastalarda postoperatif ve uzun dönem sonuçların irdelenmesi amaçlandı. Gereç ve Yöntem: Dicle Üniversitesi Tıp Fakültesi Genel Cerrahi Kliniğinde 2002-2010 tarihleri arasında İdiopatik trombositopenik purpura tanısıyla splenektomi uygulanan 109 hasta retrospektif olarak değerlendirildi. Hastalarda yaş, cinsiyet, aksesuar dalak varlığı ve yerleşimi, operasyon süresi, preoperatif transfüzyone edilen trombosit ünite sayısı, preoperatif ve postoperatif kan transfüzyon ünite sayısı, hastanede yatış süresi, takip süresi ve sonuçları, morbidite ve mortalite kaydedildi. Bulgular: Hastaların 88\'i (%80.7) kadın, 21\'i (%19.3) erkek idi. Yaş ortalamaları 37.10±16.62 (16-72) yıl idi. Ortalama ameliyat süresi 44.87 ± 10.32 (30-120) dakika idi. Ortalama kan transfüzyonu ve trombosit süspansiyonu sırasıyla 1.63±0.85(0-3) ve 2.01±0.71(1-3) ünite idi. Preoperatif USG ile 20 (%18.3) hastada aksesuar dalak tanımlandı. Has-talarda laparotomide 23\'ünde (%21.1) patoloji tarafından doğrulanan aksesuar dalak tespit edildi. İntraoperatif en sık aksesuar dalak yerleşimi dalak hilusunda saptandı. Hastaların 16\'sında (%14.7) postoperatif dönemde komplikasyon gelişti. En sık görülen komplikasyon atelektazi idi. Hastaların ortalama hastanede yatış süresi 4.56±2.45(2-12) gün idi. Hastalar medyan 28 (9-48) ay takip edildi. Hastaların 1\'inde (%0.9) mortalite gelişti. Sonuç: Splenektomi İdiopatik trombositopenik purpura tedavisinde medikal tedaviye yanıtsız olgularda güvenle uygu-lanabilen bir cerrahi girişimdir ve splenektomiyle bu hastalarda uzun süreli yanıt almak mümkündür. Nüksü engelle-mek için aksesuar dalak gözden kaçırılmamalıdır.

Anahtar Kelimeler:

İdiopatik trombositopenik purpura, splenektomi, aksesuar dalak.

Splenectomy in patients with idiopathic thrombocytopenic purpura: Analysis of 109 cases

Objectives: Splenectomy is performed in order to provide the treatment in the patients with severe idiopathic throm-bocytopenic purpura, refractory to medical treatment. In this study, we aimed to investigate the postoperatif and long-term outcomes in the patients who underwent splenectomy with the diagnosis of idiopathic thrombocytopenic pur-pura. Materials and Methods: Between 2001-2010 at Dicle University Medical Faculty, General Surgery Department, a retrospective review of the 109 patients who had undergone splenectomy for ITP was reviewed. Age, gender, pres-ence of accessory spleens and location, duration of the operation, number of preoperative platelet tranfusion, number of preoperative and postoperative blood transfusion, length of hospital stay, long-term outcomes, morbidity and mor-tality were recorded. Results: The mean age was 37.10 ± 16.62 (16-72), and there were 88 (80.7%) female and 21 (19.3%) male patients. The mean operation time was 44.87 ± 10:32 (30-120) minutes. The average postoperative blood and preoperative platelet transfusion were 1.63 ± 0.85 (0-3) and 2.01 ± 0.71 (1-3) units, respectively. The accessory spleens were en-countered in 20 (18.3%) patients at the ultrasonographic examination. And also the accessory spleens were encoun-tered in 23 (21.1%) patients during operation and confirmed with histopathologic examination. The most common lo-calization of accessory spleens were splenic hilus. The postoperative complications were occurred in 16 patients (14.7%) and the most complication was atelectasia. The mean length of hospital stay was 4:56 ± 2:45 (2-12) days. Patients were followed for an average of 28 (9-48) months. At the follow-up period, 1 (0.9 %) patient had died. Conclusion: Splenectomy can be performed safely in the treatment of the patients with idiopathic thrombocytopenic purpura unresponsive to medical treatment. Long-term good results can be obtained with splenectomy in these pa-tients. The accessory spleens should not be overlooked to prevent recurrences.

Keywords:

Idiopathic thrombocytopenic purpura, splenectomy, accessory spleen.,

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