LAPAROSKOPİK SPLENEKTOMİ: 18 OLGUNUN İNCELENMESİ

Öz

Bu çalışmanın amacı benign hematolojik hastalıklarda ve dalağın diğer nadir patolojilerinde laparoskopik splenektominin etki ve sonuçlarını ortaya koymaktır. Safra kesesi taşlarının tedavisinde altın standart olan laparoskopik kolesistektominin ortaya çıkmasından çok kısa bir süre sonra diğer karın ameliyatlarında da laparoskopik girişimler hızla yaygınlaşmıştır. Bunlardan biri de laparoskopik splenektomidir. Ege Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalında Aralık 1998-Nisan 2004 tarihleri arasında laparoskopik splenektomi uygulanan 18 hasta klinik parametreleri, hastanede kalış süreleri ve komplikasyonları irdelenerek retrospektif olarak değerlendirildi. Hastalar trombotik trombositopenik purpura, immun trombositopenik purpura, otoimmün hemolitik anemi ve dalakta kist hidatik tanılarıyla ile opere edildiler. Ortalama operasyon süresi 127.7 dk, peroperatuar kan kaybı 333 cc, ortalama dalak boyutu ve ağırlığı sırasıyla 12.5 cm ve 190 g olarak saptandı. Onbeş vakada %83.3 peroperatuar ve postoperatuar dönem sorunsuz seyretti. Üç vakada kontrol altına alınamayan splenik hiler kanama nedeniyle açık cerrahiye geçildi. Mortal seyreden vaka olmadı. Postoperatif hastanede kalış süresi ortalama 4.3 gün olarak saptandı. Güvenli ve etkili olduğu belirtilen, ancak ileri laparoskopik cerrahi beceri eğitimi gerektiren laparoskopik splenektomide deneyim arttıkça operasyon süresi kısalmakta, peroperatuar-postoperatuar komplikasyonlar ve hastanede kalış süresi azalmaktadır. Bu minimal invaziv girişim kronik hematolojik hastalıklar algoritminde daha erken değerlendirilmesi gereken bir yöntem olarak göze çarpmaktadır

Anahtar Kelimeler

• Laparoskopik splenektomi,minimal invaziv cerrahi,immün trombositopenik purpura

LAPAROSCOPIC SPLENECTOMY: EVALUATION OF 18 PATIENTS

Abstract

The aim of the study was to evaluate the effect and results of laparoscopic splenectomy in benign hematological diseases and other surgical diseases of the spleen. Thirteen initial patients, who underwent laparoscopic splenectomy between December 1998-April 2004 at our unit, were reviewed retrospectively. Data were collected regarding clinical parametrics, hospital stay and complications. Laparoscopic splenectomy was performed for thrombotic thrombocytopenic purpura TTP , immune thrombocytopenic purpura ITP , autoimmune hemolytic anemia and splenic cyst. The mean operative time was 127.7 minutes range 50-195 minutes . Mean intraoperative blood loss was 333 cc range 100- 750 cc . The mean spleen size and weight were 12.5 cm. range 9-17 cm. and 190 g range 89-425 g , retrospectively. Intraoperative and postoperative course of 15 83.3% patients remained without any complication. There were three conversions due to uncontrolled bleeding of the splenic hilum. There were no deaths. The average length of postoperative stay was 4.3 days range 2-7 days . It is believed that laparoscopic splenectomy is safe and effective. Since it needs advanced laparoscopic surgical skills, operative time, intraoperative and postoperative complications and hospital stay decreases with increased experience. Recently, laparosocopic splenectomy is the gold standard for the elective surgery of normal sized spleens. We believe that laparoscopic splenectomy, which provides long term prevention for ITP and TTP relapses, should be considered earlier in the algorithm of hematological diseases

Keywords

• Laparoscopic splenectomy,minimal invasive surgery,immane thrombocytopenic porpora

References

1. Katkhouda N, Mavor E. Laparoscopic splenectomy. Surg Clin North Am 2000; 80:1285-1297.
2. Delaitre B, Maignien B. Splenectomy by the coelioscopic approach: Report of a case. Presse Med 1991; 20: 2263.
3. Glasgow RE, Yee LF, Mulvihill SJ. Laparoscopic splenectomy: The emerging standard. Surg Endosc 1997; 11: 108-112.
4. Chu UB, Park A, Mastrangelo MJ. Laparoscopic splenectomy. Curr Surg 2001; 58:63-67.
5. Park A, Targarona EM, Trias M. Laparoscopic surgery of the spleen: state of the art. Langenbeck’s Arch Surg 2001; 386: 230
6. Berends FJ, Schep N, Cuesta MA, Bonjer HJ, Kappers-Klunne MC, Huijgens P, Kazemier G. Hematological long-term results of laparoscopic splenectomy for patients with idiopathic thrombocytopenic purpura. Surg Endosc 2004; 18: 766-770.
7. Friedman RL, Fallas MJ, Carroll BJ, Hiatt JR, Phillips EH. Laparoscopic splenectomy for ITP: The gold standard. Surg Endosc ; 10: 991-995. Katkhouda N, Hurwitz MB, Rivera RT, Chandra M, Waldrep DJ, Gugenheim J, Mouiel J. Laparoscopic splenectomy: Outcome and efficacy in 103 consecutive patients. Ann Surg 1998; 228: 568-578.
8. Decker G, Millat B, Guillon F, Atger J, Linon M. Laparoscopic splenectomy for benign and malignant hematologic diseases: 35 consecutive cases. World J Surg 1998, 22: 62-68.

9. Katkhouda N, Hurwitz MB, Rivera RT, Chandra M, Waldrep DJ, Gugenheim J, Mouiel J. Laparoscopic splenectomy: outcome and efficacy in 103 consecutive patients. Ann Surg 1998; 228: 568-578.
10. Shimomatsuya T, Horiuchi T: Laparoscopic splenectomy for treatment of patients with idiopathic thrombocytopenic purpura. Comparison with open splenectomy. Surg Endosc 1999; 13: 563-566.
11. Szold A, Schwartz J, Abu-Abeid S, Bulvik S, Eldor A. Laparoscopic splenectomies for idiopathic thrombocytopenic purpura: experience of sixty cases. Am J Hematol 2000; 63: 7-10.
12. Delaitre B, Pitre J. Laparoscopic splenectomy versus open splenectomy: a comperative study. Hepatogastroenterology 1997; :45-49.
13. Friedman RL, Hiatt JR, Korman JL, Facklis K, Cymerman J, Phillips EH. Laparoscopic or open splenectomy for hematologic disease: which approach is superior? J Am Coll Surg 1997; 185: 49-54.
14. Park A, Marcaccio M, Sternbach M, Witzke D, Fitzgerald P. Laparoscopic vs open splenectomy. Arch Surg 1999; 134: 1263
15. Khoury G, Abiad F, Geagea T, Nabout G, Jabbour S. Laparoscopic treatment of hydatid cysts of the liver and spleen. Surg Endosc 2000; 14: 243-245.
16. Mc Lean AL, Broussard E, McCarter MD, Calvo T, Lopresti P, Marzulli V, Fahey III TJ. Contemp Surg 2000; 56: 541-544.
17. Glasgow RE, Mulvihill SJ. Laparoscopic splenectomy. World J Surg 1999; 23: 384-388.
18. Gigot JF, Jamar F, Ferrant A, van Beers BE, Lengele B, Pauwels S, Pringot J, Kestens PJ, Gianello P, Detry R: Inadequate detection of accessory spleens and splenosis with laparoscopic splenectomy. Surg Endosc 1998; 12: 101-106.
19. Gigot JF, Jamar F, Ferrant A, van Beers BE, Lengele B, Pauwels S, Pringot J, Kestens PJ, Gianello P, Detry R. Inadequate detection of accessory spleens and splenosis with laparoscopic splenectomy. A shortcoming of the laparoscopic approach in hematologic diseases. Surg Endosc 1998; 12: 101-106.