Kerim Bora YILMAZ, Can ATALAY, Meltem YÜKSEL, Nİyazi KARAMAN, Cihangir ÖZASLAN

İdiyopatik trombositopenik purpura nedeniyle splenektomi yapılan hastaların tedavi sonuçlarının değerlendirilmesi

Amaç: Bu çalışmada, idiyopatik trombositopenik purpura nedeniyle splenektomi yapılan hastaların tedavi sonuçlarınının değerlendirilmesi amaçlandı. Hastalar ve Yöntem: 1999-2006 yılları arasında idiyopatik trombositopenik purpura tanısıyla splenektomi yapılan hastalar retrospektif olarak değerlendirildi. Hastaların yaşı, cinsiyeti, cerrahi öncesi ve sonrası uygulanan medikal tedaviler, tedavi başlangıcından cerrahiye kadar geçen süre, aşılanma durumu, uygulanan cerrahi tedavi, aksesuar dalak varlığı ve cerrahi sonrası gelişen komplikasyonlar kaydedilerek hastaların ameliyat sonrası erken ve geç dönemdeki trombosit yanıtları incelendi. Bulgular: Çalışmaya ortalama yaşı 38 (14-67) olan beş erkek ve sekiz kadın hasta alındı. Hastaların hepsinde ilk başvuru bulgusu kanamaydı. Medikal tedavi sonucunda hastaların ikisinin steroide bağımlı, 11'inin ise steroide yanıtsız olduğu saptanarak splenektomi uygulandı. Postoperatif komplikasyon olarak iki hastada geçici kanama ve hematom saptanırken, iki hastada pnömoni gözlendi. Postoperatif kısa dönem takipte 11 (%84) hastada tam yanıt, bir (%8) hastada parsiyel yanıt elde edilirken bir (%8) hastada ise yanıt olmadığı gözlemlendi. Hastaların uzun dönem takiplerinde ise dokuz (%69) hastada tam yanıt, bir (%8) hastada parsiyel yanıt alınırken, üç (%23) hasta da yanıtsız olarak değerlendirildi. Sonuç: Splenektomi kronik idiyopatik trombositopenik purpura tedavisinde medikal tedaviye yanıtsız olgularda güvenle uygulanabilen bir cerrahi girişimdir ve splenektomiyle bu hastalarda uzun süreli yanıt almak mümkündür.

Evaluation of treatment results of patients treated with splenectomy for idiopathic thrombocytopenic purpura

Purpose: The treatment results of patients treated with splenectomy for idiopathic thrombocytopenic purpura were evaluated in this study. Patients and Methods: Patients treated with splenectomy for idiopathic trombocytopenic purpura between 1999-2006 were retrospectively evaluated. Patients age, gender, preoperative and postoperative medical treatments, duration from the beginning of the treatment to surgery, vaccination status, type of surgical treatment, presence of accessory spleen, and postoperative complications were recorded and early and late postoperative trombocyte responses were evaluated. Results: Five male and eight female patients with a mean age of 38 (14-67) were included in the study. Bleeding was the presenting sign in all patients. Splenectomy was performed since two patients were dependent on and 11 patients were unresponsive to steroid treatment. Two patients had temporary bleeding and hematoma whereas two patients had pneumonia as postoperative complications. Eleven patients (84%) had complete response, one patient (8%) had partial response and one patient (8%) was unresponsive in early postoperative follow-up period. During long-term follow-up, nine patients (69%) had complete response, one patient (8%) had partial response and three patients (23%) were unresponsive to splenectomy. Conclusion: Splenectomy can be performed safely in idiopathic trombocytopenic purpura patients unresponsive to medical treatment to obtain sustained response.

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