Splenektomi Endikasyonlarının Klinikopatolojik Değişkenlere Göre Karşılaştırılması

Yıl 2022, Cilt: 15 Sayı: 1, 43 - 50, 30.04.2022

Tolga Kalaycı , Mustafa Yeni

https://doi.org/10.52976/vansaglik.1003006

Öz

Amaç: Bu çalışmanın amacı benign ve malign hastalıkları nedeniyle splenektomi uygulanan hastaların ameliyat öncesindeki, ameliyat sırasındaki ve ameliyat sonrasındaki farklılıklarını değerlendirmektir.
Gereç ve Yöntem: Ocak 2015-Ocak 2021 tarihleri arasında üçüncü basamak bir sağlık kuruluşunda splenektomi yapılan yetişkin hastalar (18 yaş ve üzeri) geriye dönük olarak tarandı. Hastalar, benign hastalıklar nedeniyle splenektomi uygulanan hastalar (n=35) ve malignite cerrahisi sırasında splenektomi uygulanan hastalar (n=45) olmak üzere iki ana gruba ayrıldı. Öte yandan, benign endikasyonlar da üç alt gruba ayrıldı. Hastaların tıbbi kayıtlarından elde edilen klinikopatolojik değişkenler, hem ana gruplar hem de alt gruplar arasında karşılaştırıldı.
Bulgular: Çalışma kriterlerine uyan 80 hastanın yaş ortalaması 53.47±18.28 (18-86) olup 44 hasta (%55) kadındı. Hastaların ortalama yaşı, laparoskopik cerrahi oranı, elektif cerrahi oranı, postoperatif komplikasyon oranı, eritrosit süspansiyonu ve taze donmuş plazma ihtiyacı, hastanede kalış süresi ve yoğun bakımda kalış süresi malignite grubunda daha yüksekti. Ayrıca son yıllarda malignite nedeniyle splenektomi olguları oransal olarak daha fazla idi. Çalışmanın bir diğer önemli sonucu da travmatik splenektomilerin daha uzun hastane yatışı gerektirmesi ve bu hastaların klinik yönetiminin diğer iyi huylu splenektomi nedenlerine göre daha zor olması idi.
Sonuç: Tüm splenektomi olguları arasında malign splenektomi olguları ve benign splenektomi olguları arasında travmatik splenektomi uygulanan olgular hastanede kalış süresinin daha uzun olması, kan ürünlerine daha fazla ihtiyaç duyulması ve morbidite oranlarının yüksek olması nedeniyle yönetimi zordur.

Anahtar Kelimeler

malignite, morbidite, mortalite, splenektomi, travma

Comparison of Splenectomy Indications According to Clinicopathological Variables

Öz

Background: The aim of this study is to evaluate the preoperative, intraoperative and postoperative differences in patients who underwent splenectomy for benign and malignant diseases.
Materials and Methods: Adult patients (18 years and older) who underwent splenectomy in a tertiary health center between January 2015 and January 2021 were searched retrospectively. The patients were divided into two main indication groups: patients who underwent splenectomy for benign diseases (n=35) and patients who underwent splenectomy during malignancy surgery (n=45). In addition, benign indications were also divided into three subgroups. Clinicopathological variables obtained from the patients' medical records were compared between both main groups and subgroups.
Results: The mean age of 80 patients who met the study criteria was 53.47±18.28 (18-86), and 44 patients (55%) were female. The mean age of the patients, laparoscopic surgery rate, elective surgery rate, postoperative complication rate, need for erythrocyte suspension and fresh frozen plasma, length of hospital stay and length of stay in the intensive care unit were higher in the malignancy group. In addition, splenectomy cases due to malignancy were proportionally higher in recent years. Another important result of the study was that traumatic splenectomies require longer hospitalization, and the management of these patients' clinics is more difficult than other benign splenectomy causes.
Conclusion: Among all splenectomy cases, malignant splenectomy cases and benign splenectomy cases who underwent traumatic splenectomy are difficult to manage because of longer hospital stay, more need for blood products, and high morbidity rates.

Anahtar Kelimeler

malignancy, morbidity, mortality, splenectomy, trauma

Kaynakça

• Ahmad, I., Saleem, S., Anjum, S., & Rehan, A. (2017). SPLENECTOMY. The Professional Medical Journal, 24(09), 1322-1326.
• Ardestani, A., & Tavakkoli, A. (2013). Laparoscopic versus open splenectomy: the impact of spleen size on outcomes. Journal of Laparoendoscopic & Advanced Surgical Techniques, 23(9), 760-764.
• Arshed, M. S., Qureshi, S., Channa, A., & Maher, M. (2011). Audit of splenectomy at Jinnah postgraduate medical centre, Karachi. Journal of Ayub Medical College Abbottabad, 23(3), 79-81.
• Balague, C., Targarona, E., Cerdan, G., Novell, J., Montero, O., Bendahan, G., . . . Diaz, M. (2004). Long-term outcome after laparoscopic splenectomy related to hematologic diagnosis. Surgical Endoscopy and Other Interventional Techniques, 18(8), 1283-1287.
• Beuran, M., Gheju, I., Venter, M., Marian, R., & Smarandache, R. (2012). Non-operative management of splenic trauma. Journal of medicine and life, 5(1), 47.
• Bonnet, S., Guedon, A., Ribeil, J.-A., Suarez, F., Tamburini, J., & Gaujoux, S. (2017). Indications and outcome of splenectomy in hematologic disease. Journal of visceral surgery, 154(6), 421-429.
• Buffet, P. A., Milon, G., Brousse, V., Correas, J.-M., Dousset, B., Couvelard, A., . . . Paye, F. (2006). Ex vivo perfusion of human spleens maintains clearing and processing functions. Blood, 107(9), 3745-3752.
• Bulus, H., Mahmoud, H., Altun, H., Tas, A., & Karayalcin, K. (2013). Outcomes of laparoscopic versus open splenectomy. Journal of the Korean Surgical Society, 84(1), 38.
• Cadeddu, M., Garnett, A., Al-Anezi, K., & Farrokhyar, F. (2006). Management of spleen injuries in the adult trauma population: a ten-year experience. Canadian journal of surgery, 49(6), 386.
• Erözgen, F., Benek, S., Kızılkaya, M. C., Koyuncu, A., Ayer, M., Ersoy, Y. E., . . . Hut, A. (2013). Benign ve Malign Dalak Hastalıklarında Cerrahi Splenektomi Endikasyonları ve Minimal İnvaziv Cerrahinin Yeri. Istanbul Medical Journal, 14(2).
• Hamlat, C. A., Arbabi, S., Koepsell, T. D., Maier, R. V., Jurkovich, G. J., & Rivara, F. P. (2012). National variation in outcomes and costs for splenic injury and the impact of trauma systems: a population-based cohort study. Annals of surgery, 255(1), 165-170.
• Hill, J., Walsh, R. M., McHam, S., Brody, F., & Kalaycio, M. (2004). Laparoscopic splenectomy for autoimmune hemolytic anemia in patients with chronic lymphocytic leukemia: a case series and review of the literature. American journal of hematology, 75(3), 134-138.
• Kristinsson, S. Y., Gridley, G., Hoover, R. N., Check, D., & Landgren, O. (2014). Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up. haematologica, 99(2), 392.
• Leone, G., & Pizzigallo, E. (2015). Bacterial infections following splenectomy for malignant and nonmalignant hematologic diseases. Mediterranean journal of hematology and infectious diseases, 7(1).
• Misiakos, E. P., Bagias, G., Liakakos, T., & Machairas, A. (2017). Laparoscopic splenectomy: Current concepts. World journal of gastrointestinal endoscopy, 9(9), 428.
• Moorjani, R. G., Marchena-Gomez, J., Casimiro-Perez, J., Roque-Castellano, C., & Ramirez-Felipe, J. (2014). Morbidity-and mortality-related prognostic factors of nontraumatic splenectomies. Asian journal of surgery, 37(2), 73-79.
• Mufti, T. S., Akbar, I., & Ahmed, S. (2007). Experience with splenic trauma in Ayub teaching hospital, Abbottabad. Journal of Ayub Medical College Abbottabad, 19(3), 3-5.
• Musallam, K. M., Khalife, M., Sfeir, P. M., Faraj, W., Safadi, B., Abi Saad, G. S., . . . Peyvandi, F. (2013). Postoperative outcomes after laparoscopic splenectomy compared with open splenectomy. Annals of surgery, 257(6), 1116-1123.
• Park, A., Marcaccio, M., Sternbach, M., Witzke, D., & Fitzgerald, P. (1999). Laparoscopic vs open splenectomy. Archives of Surgery, 134(11), 1263-1269.
• Santos, F. P., Tam, C. S., Kantarjian, H., Cortes, J., Thomas, D., Pollock, R., & Verstovsek, S. (2014). Splenectomy in patients with myeloproliferative neoplasms: efficacy, complications and impact on survival and transformation. Leukemia & lymphoma, 55(1), 121-127.
• Ugur, M., Kilic, E., Emre, A., Sanlı, A. N., Ozturk, O. U., Yetim, I., & Temiz, M. Scholars Journal of Applied Medical Sciences (SJAMS) ISSN 2320-6691 (Online).
• Wang, X., Li, Y., Crook, N., Peng, B., & Niu, T. (2013). Laparoscopic splenectomy: a surgeon’s experience of 302 patients with analysis of postoperative complications. Surgical endoscopy, 27(10), 3564-3571.
• Weledji, E. P. (2014). Benefits and risks of splenectomy. International Journal of Surgery, 12(2), 113-119.
• Wysocki, M., Radkowiak, D., Zychowicz, A., Rubinkiewicz, M., Kulawik, J., Major, P., . . . Budzyński, A. (2018). Prediction of technical difficulties in laparoscopic splenectomy and analysis of risk factors for postoperative complications in 468 cases. Journal of clinical medicine, 7(12), 547.