Retropubik Radikal Prostatektomi Operasyonunda Peroperatif Kanama Miktarını ve Kan Transfüzyonu İhtiyacını Etkileyen Faktörler

Öz

İntraoperatif kan kaybı radikal prostatektominin önemli komplikasyonlarından biridir. Perioperatif uygun risk sınıflamasının yapılması intraoperatif kan transfüzyonu ihtimalini azaltabilir. Biz bu çalışmada kanamaya neden olabilecek risk faktörlerini ortaya koymayı amaçladık. Çalışmamıza konvansiyonel transrektal ultrasonografi biyopsi (TRUS-Bx) ile prostat kanseri tanısı konulan ve retropubik radikal prostatektomi (RP) operasyonu gerçekleştirilen 180 hasta dahil edildi. Operasyonda gerçekleşen ortalama kan kaybı ile hastanın klinik ve patolojik bulgularının ilişkisi incelendi. Kanama miktarına etki edebilecek ve operasyon öncesi kanama miktarını öngörebilecek faktörler ortaya konulmaya çalışıldı. Kanama miktarı fazla olan hastalarda TRUS-Bx ile RP arasında geçen süre istatistiksel anlamlı olarak daha uzundu (p=0.005). Peroperatif kanama düzeyi ile TRUS-Bx ve RP ISUP skorlarının karşılaştırıldığında, kanama miktarı yüksek olan (>845 cc) hastalarda hem TRUS-Bx hem de RP ISUP değerleri istatistiksel olarak anlamlı daha yüksek izlendi (sırasıyla; p=0,024, p<0,001). TRUS-Bx ISUP skorunda 1 birimlik artış, peroperatif kanama miktarında 100.04 cc artışla ilişkili bulunmuştur. Lojistik regresyon analizinde peroperatif kanama miktarı için en önemli prediktör RP ISUP derecesiydi (p=0,003). Yüksek evre hastalarda operasyon sırasında kanama daha çok olmaktadır. ISUP derecesi ve biyopsi tümör yüzdesi yüksek olan hastalarda daha dikkatli bir diseksiyon, peroperatif kanama miktarını azaltabilir. Intraoperatif kanama miktarı fazla olan hastalarda kanser evresinin biyopsi patolojisine göre daha yüksek olabileceği unutulmamalıdır.

Anahtar Kelimeler

• Prostat kanseri
• kanama
• prostatektomi

Factors Affecting Peroperative Bleeding Amount and Need for Blood Transfusion in Retropubic Radical Prostatectomy Operation

Öz

Intraoperative blood loss is one of the important complications of radical prostatectomy. Appropriate perioperative risk stratification may reduce the possibility of intraoperative blood transfusion. In this study, we aimed to reveal the risk factors that may cause bleeding. 180 patients who were diagnosed with prostate cancer by conventional transrectal ultrasonography biopsy (TRUS-Bx) and underwent retropubic radical prostatectomy (RP) were included in our study. The relationship between the mean blood loss during the operation and the clinical and pathological findings of the patient was examined. Factors that could affect the amount of bleeding and predict the amount of bleeding before the operation were tried to be revealed. The time between TRUS-Bx and RP was statistically significantly longer in patients with a large amount of bleeding (p=0.005). When the level of peroperative bleeding was compared with the TRUS-Bx and RP ISUP scores, both TRUS-Bx and RP ISUP values were statistically significantly higher in patients with high bleeding (>845 cc) (respectively; p=0.024, p<0.001). A 1-unit increase in the TRUS-Bx ISUP score was associated with an increase of 100.04 cc in the amount of peroperative bleeding. In the logistic regression analysis, the most important predictor for the amount of perioperative bleeding was RP ISUP grade (p=0.003). In high-stage patients, bleeding occurs more during the operation. In patients with an ISUP grade and a high biopsy tumor percentage, more careful dissection may reduce the amount of perioperative bleeding. It should be kept in mind that the cancer stage may be higher than the biopsy pathology in patients with a large amount of intraoperative bleeding.

Anahtar Kelimeler

• Prostate cancer
• bleeding
• prostatectomy

Kaynakça

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