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

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

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