SPLENEKTOMİ YAPILAN HASTALARDA POSTOPERATİF KOMPLİKASYON GELİŞİMİNİN PORTAL VEN TROMBOZUNA ETKİSİ

Year 2023, Volume: 86 Issue: 4, 354 - 359, 01.12.2023

Veysel Umman , Hafize Basut Atalay , Recep Temel , Turan Alisoy , Kaan Balcı , Sedat Fırat Okutan , Taylan Özgür Sezer , Özgür Fırat , Sinan Ersin

https://doi.org/10.26650/IUITFD.1352652

Abstract

Amaç: Terapötik ve acil splenektomi sonrası gelişen önemli komplikasyonlardan biri venöz tromboembolidir. Hematolojik malignite nedeniyle splenektomi sonrası ilk iki ay içerisinde %35’e varan portal ve splenik venöz tromboembolizm bildirilmiştir. Bu çalışmada, acil ve elektif splenektomi operasyonlarını ve komplikasyonlarını karşılaştırarak portal ven trombozu (PVT) gelişimi üzerindeki risklerin incelenmesi amaçlandı.
Gereç ve Yöntem: Çalışmaya 2017-2023 yılları arasında gerçekleştirilen ve kayıtları eksiksiz olan 78 splenektomi vakası dahil edildi. Bu vakalardan 39'u acil, 39'u ise elektif prosedürlerdi. İki grup portal tromboembolizm ve riskleri açısından retrospektif olarak karşılaştırıldı.
Bulgular: Ameliyat sonrası komplikasyon görülmesi ile PVT gelişimi riski arasında anlamlı bir ilişki saptanmıştır (p=0,004). Operasyon tipi olarak inclediğimizdeyse ameliyat sonrası ilk iki haftalık süreçteki acil vakalarda PVT gelişimi riski, elektif vakalara göre anlamlı ölçüde yüksek bulunmuştur (p=0,048). Ayrıca, kısa ameliyat süresi, büyük dalak boyutu, düşük trombosit sayısı ve patoloji sonuçlarında malignite olması elektif vakalar lehine anlamlı bulunmuştur (sırasıyla p=0,007, p=0,004, p<0,001, p=0,001, p=0,001). Acil vakalardaysa kan replasmanı ihtiyacı ve komplikasyonlar daha sık görülmüştür (sırasıyla p<0,001, p=0,021).
Sonuç: Yüksek riskli hastalar ameliyat sonrasındaki dönemde ve taburculuk sonrasında düşük molekül ağırlıklı heparin ile profilaktik antikoagülasyon açısından değerlendirilmelidir. Acil splenektomi vakalarında kar/zarar oranı göz önünde bulundurularak antikoagülasyon düşünülmeli ve olası venöz tromboemboli için şüphe eşiği düşük tutulup erken tetkik edilmelidir. Bu anlamda çalışmamız güncel sonuçları ile mevcut verileri desteklemektedir.

Keywords

Splenektomi, portal tromboz, acil cerrahi, splenomegali

IMPACT OF POSTOPERATIVE COMPLICATIONS ON PORTAL THROMBOSIS IN SPLENECTOMY PATIENTS

Abstract

Objective: Venous thromboembolism is one of the significant complications after elective and emergency splenectomy. Up to 35% of portal and splenic venous thromboembolism has been reported in the first two months after splenectomy for hematologic malignancy. Our objectives were to compare emergency and elective splenectomy and their complications, and to analyze the risks on the development of portal vein thrombosis (PVT).
Material and Method: A total of 78 splenectomy cases performed between 2017-2023 and that had complete medical records were included in this study. Of these cases, 39 were emergency and 39 were elective procedures. The two groups were compared retrospectively for risks of PVT.
Result: We found a significant relationship between the development of postoperative complications and the risk of PVT (p=0.004). The risk of developing PVT in emergency cases in the post-operative 2 weeks was significantly higher than elective cases (p=0.048). Shorter operation times, larger spleen sizes, lower platelet counts and malignancy in pathology results were found to be significantly in favor of elective cases (p=0.007, p=0.004, p<0.001, p=0.001, respectively). In emergency cases, the need for RBC transfusion and complications were more frequent (p<0.001, p=0.021).
Conclusion: High-risk patients should be evaluated for prophylacticanticoagulation with low-molecular-weight heparin in the postoperative period and after discharge. Anticoagulation should be considered for emergency splenectomy, factoring in cost-benefit, and a low suspicion for venous thromboembolism should be maintained with timely investigation. In this sense, our study supports the existing data with its current results.

Keywords

Splenectomy, portal thrombosis, emergency surgery, splenomegaly

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