Eyüp KEBAPÇI, Cezmi KARACA, Ayça TAN, Mehmet GÖRGÜN, Sedat TAN

İmmun trombositopenik purpurada splenektomi sonrası yineleme

Çalışmamızda, immun trombositopenik purpura nedeniyle splenektomi yapılan hastalarda, yineleme oranı ve buna etki eden nedenleri değerlendirip sonuçları literatür eşliğinde tartışmayı amaçladık. İmmun trombositopenik purpura nedeni ile splenektomi yapılan 36 hasta çalışma kapsamına alındı. Hastalar yaş ve cinsiyet yönünden değerlendirildi. Takipli olan 25 hasta ortalama 24 ay izlendi. Yineleme oranı ve buna etki edebilecek nedenler olarak ameliyatın açık veya kapalı olması, cinsiyet, yaş, ameliyat öncesi ve sonrası 2. gün trombosit değerleri değerlendirilerek literatür eşliğinde tartışıldı. On üç hasta (%36,1) erkek, 23 hasta (% 63,9) hasta kadın idi. Ortalama yaş 37,7 idi. Aksesuar dalak 4 hastada (%11,1) bulundu. İzlenen 25 hastanın, 5inde (%20) yineleme, 1inde (%4) ise parsiyel yineleme saptandı. Kadınlarda ve 40 yaş üzerindekilerde yineleme oranı fazla olsa da istatistiksel olarak anlamlı değildi. Ameliyat sonrası 2. gün alınan trombosit değeri 156000/ml altında olanlarda, bu değerin üstünde olanlara göre yineleme oranı fazla ve istatistiksel olarak anlamlı idi (p=0,024). İmmun trombositopenik purpura cerrahi tedavisinde yinelemeyi tamamen önlemek en iyi şartlarda dahi mümkün olamamaktadır. Bu nedenle ameliyat sonrası 2. gün alınan trombosit değerleri ile yineleme olabilecek hastaları saptayıp daha sık kontrol altında tutmanın yerinde olacağını düşünmekteyiz.

Recurrence in immune thrombocytopenic purpura after splenectomy

In our study, we aimed to evaluate and discuss the recurrence rate and the causes for recurrences in splenectomy due to immune thrombocytopenic purpura. Thirty-six patients who had splenectomy due to immune thrombocytopenic purpura, enrolled in the study. Patients were evaluated for age and gender. Twenty-five patients were followed at a mean of 24 months. Recurrence rate and causes for recurrences; laparoscopic or open surgery, gender, age, preoperative and postoperative 2nd day platelet count were evaluated and discussed with the data in the literature. Thirteen patients (36.1%) were male and 23 patients (63.9%) patients were female. Mean age was 37,7. Accessory spleen was found in 4 patients (11.1%). In the follow-up of 25 patients, 5 patients (20%) had recurrence, 1 patient (4%) had partial recurrence. Although the recurrence rate was higher in woman and over 40 year old group, this was not statistically significant. The recurrence rate of patients, whose platelet count below 156.000/ml in postoperatively 2nd day, was significantly more than the patients whose platelet count above this value (p=0,024). Even under the best conditions, it is not possible to completely avoid the recurrences in surgical treatment of immune thrombocytopenic purpura. Therefore, we think it would be helpful to identify the patients with postoperatively 2nd day platelet count who have possibility for recurrence and keep those under control more often.

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