İmmün trombositopenik purpura tanılı hastalarda laparoskopik splenektomiye yanıt: Tek merkez verilerinin değerlendirilmesi

Yıl 2019, Cilt: 33 Sayı: 2, 121 - 127, 27.09.2019

Cihan Ağalar Aybüke Olgun Mücahit Özbilgin Koray Atila Ali Durubey Çevlik Serhan Derici Özden Pişkin Sermin Özkal Tufan Egeli Tarkan Ünek

Öz

Amaç: İmmün trombositopenik purpura (İTP),
edinilmiş trombositopeninin en sık nedenlerinden biridir. İmmün trombositopenik
purpura tanılı hastaların ikinci sıra tedavisinde laparoskopik splenektomi (LS)
yaygın olarak uygulanmaktadır. Bu çalışmanın amacı merkezimizde İTP nedeniyle
LS uygulanan hastaların peri-operatif ve uzun dönem sonuçlarını Vicenza
konsensüs kriterleri çerçevesinde değerlendirmektir.

Gereç ve Yöntem: 2010-2017 yılları
arasında İTP tanısıyla merkezimizde LS uygulanan hastaların demografik ve
ameliyat verileri, morbidite, mortalite ve tedavi yanıtları, prospektif olarak
toplanan veri tabanından retrospektif olarak değerlendirildi.

Bulgular: Çalışmaya 38 hasta (14
Erkek – 24 Kadın) dahil edildi. Hastaların ortalama yaşı 38.89 ± 16.13 (18-70)
idi. Ortalama ameliyat süresi 71,57±20,43 (45-135) dakika olarak ölçüldü.
Cerrahi esnasında ortalama kanama miktarı 43,28±49,21(10-250) cc. olup,
hastaların hiçbirinde peri-operatif mortalite görülmedi. Üç hastada (%7,8)
minör morbidite izlendi. Ortalama hastane yatış süresi 4,2±1,3 (2-7) gün idi.
Vicenza konsensüs kriterlerine göre 25 hasta (%73,5) tam yanıtlı, 2 hasta
(%5,3) yanıtlı, 4 hasta (%11,8) yanıtsız, 3 hasta (%8,8) yanıt kayıplı olarak
değerlendirildi. Hastaların yaşı ile splenektomiye yanıtları arasında anlamlı
ilişki saptanmadı (p=0,43). Hastaların ortalama takip süresi 38,15 ± 25,24
(6,53 - 88,57) ay idi.

Sonuç: İmmün trombositopenik purpura
tanılı hastaların ikinci sıra tedavisinde LS düşük morbidite ve mortalite ile
uygulanabilir.

Anahtar Kelimeler

immün trombositopenik purpura, İTP, laparoskopik splenektomi, tedavi yanıtı, morbidite, mortalite

RESPONSE TO LAPAROSCOPIC SPLENECTOMY IN PATIENTS WITH IMMUNE THROMBOCYTOPENIC PURPURA: EVALUATION OF SINGLE CENTER DATA

Öz

Objective:
 Immune thrombocytopenic purpura (ITP) is one of the
most common causes of acquired thrombocytopenia. Laparoscopic splenectomy (LS)
is widely applied in the second line treatment of patients with ITP. The aim of
this study is to evaluate the peri-operative and long-term results of patients
with ITP, who underwent LS, according to Vicenza consensus criteria.

Material
and Method: The demographic and operative data, morbidity,
mortality and treatment responses of the patients with ITP, who underwent LS in
our center, between 2010 and 2017 were analyzed retrospectively from
prospectively collected database

Results: Thirty-eight
patients (14 male - 24 female) were included in the study. The mean age of the
patients was 38.89±16.13 (18-70). The mean operation duration was 71.57±20.43
(45-135) minutes. The mean bleeding amount during surgery was 43.28±49.21
(10-250) cc. No peri-operative mortality was observed in any of the patients.
Minor morbidity was observed in three patients (7.8%). The mean hospital stay
was 4.2±1.3 (2-7) days. According to Vicenza consensus criteria, 25 patients
(73.5%) had complete response, two patients (5.3%) had response, four patients
(11.8%) were evaluated as non-responsive and 3 patients (8.8%) had loss of
response. No significant relationship was identified between the age of the
patients and their response to splenectomy (p = 0.43). The mean follow-up
period was 38.15 ± 25.24 months (6.53 - 88.57).

Conclusion: Laparoscopic splenectomy can be
applied with low morbidity and mortality in the second line treatment of
patients with ITP.

Anahtar Kelimeler

immune thrombocytopenic purpura, ITP, laparoscopic splenectomy, treatment response, morbidity, mortality

Kaynakça

• Lambert MP,Gernsheimer TB. Clinical updates in adult immune thrombocytopenia. Blood. 2017;25(21):2829–35.
• Cuker A, Cines DB, Neunert CE. Controversies in the treatment of immune thrombocytopenia. Curr Opin Hematol. 2016;23(5):479–85.
• Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115(1):168–86.
• Rijcken E, Mees ST, Bisping G, et al. Laparoscopic splenectomy for medically refractory immune thrombocytopenia (ITP): A retrospective cohort study on longtime response predicting factors based on consensus criteria. Int J Surg; 2014;12(12):1428–1433.
• Rodeghiero F, Stasi R, Gernsheimer T, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: Report from an international working group. Blood 2009;113(11):2386–2393.
• Clavien P a, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–196.
• Delaitre B, Maignien B. Splenectomy by the laparoscopic approach. Report of a case. Press Med. 1991;20(44):2263.
• Kojouri K, Vesely SK, Terrell DR, George JN. Splenectomy for adult patients with idiopathic thrombocytopenic purpura : a systematic review to assess long-term platelet count responses , prediction of response , and surgical complications. Blood. 2004;104(9):2623–35.
• Wysocki M, Radkowiak D, Zychowicz A, et al. Prediction of Technical Difficulties in Laparoscopic Splenectomy and Analysis of Risk Factors for Postoperative Complications in 468 Cases. J Clin Med. 2018;7(12):547.
• Fabris F, Tassan T, Ramon R, et al. Age as the major predictive factor of long-term response to splenectomy in immune thrombocytopenic purpura. Br J Haematol. 2001;112:637–640.
• Shojaiefard A, Mousavi SA, Faghihi SH, Abdollahzade S. Prediction of response to splenectomy in patients with idiopathic thrombocytopenic purpura. World J Surg. 2008;32(3):488–493.
• Mikhael J, Northridge K, Lindquist K, Kessler C, Deuson R, Danese M. Short-term and long-term failure of laparoscopic splenectomy in adult immune thrombocytopenic purpura patients: A systematic review. Am J Hematol. 2009;84(11):743–748.
• Thanarajasingam G, Vaidya R, Erie A, Wolanskyj AP. Accessory splenectomy for refractory immune thrombocytopenic purpura. Am J Hematol. 2011;86:520–523.
• Zheng D, Huang C-S, Huang S-B, Zheng C-X. Laparoscopic splenectomy for primary immune thrombocytopenia: Current status and challenges. World J Gastrointest Endosc. 2016;8(17):610.
• Cheng G. Eltrombopag, a thrombopoietin- receptor agonist in the treatment of adult chronic immune thrombocytopenia: A review of the efficacy and safety profile. Ther Adv Hematol. 2012;3(3):155–164.
• Ghanima W, Godeau B, Cines DB, Bussel JB. How I treat immune thrombocytopenia: The choice between splenectomy or a medical therapy as a second-line treatment. Blood. 2012;120(5):960–969.
• Thai LH, Mahévas M, Roudot-Thoraval F, et al. Long-term complications of splenectomy in adult immune thrombocytopenia. Med (United States). 2016;95(48):5098.