Hematolojik hastalıklarda splenektomi sonrası mortalite ve morbiditeyi etkileyen faktörler (Retrospektif çalışma)
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Tarih
2015
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info:eu-repo/semantics/closedAccess
Özet
Birçok hematolojik hastalıkta ve sendromda hipersplenizm görülebilir. Hiperpslenizm bulgularının ortadan kaldırılması, dalak yaralanması ve hematolojik malignensilerde evrelemenin yapılması amacı ile splenektomi yapılmaktadır. Bu çalışmada Dicle Üniversitesi Tıp Fakültesi Hastanesi Genel Cerrahi Kliniği'nde, 1 Ocak 2005 ile 1 Kasım 2008 tarihleri arasında hematolojik hastalıklar nedeniyle splenektomi yapılmış 48 hastanın retrospektif analizi yapıldı. Hasta dosyaları taranıp veriler elde edildi. Olguların hastanede yattıkları süre içerisindeki postoperatif komplikasyonları araştıırldı. Hastaların 21'i erkek, 27'si kadın idi. Hastaların yaş ortalaması 36.65 ± 15.58 idi. Çalışmaya alınan 48 hastanın 29'u Kr. ITP, 5'i ITP, 5'i lenfoma, 3'ü herediter sferositoz, 2'si hemolitik anemi ve 1'er hasta KLL, myelofibrozis, talasemi major ve talasemi intermedia nedeniyle opere edilmişti. Hastanede yatış süresi ortalama 7.31 ± 3.45 gün idi. Klinikte en uzun süre yatış hemolitik anemilerde 22 gün, myelofibroziste 17 gün ve talasemi majorde 12 gün iken daha kısa süreli yatışların KLL, lenfoma, talasemi intermedia gibi hastalıklarda olduğu görüldü. Dalak büyüklüğü normal sınırlarının 80-120 mm olduğu dikkatte alındığında H.sferositoz, KLL, lenfoma, miyelofibrozis ve talasemi major hastalıklarında dalak büyüklükleri sınırların üstünde tespit edildi. Preoperatif 11 hastaya, postoperatif 14 hastaya kan transfüzyonu yapıldı. Hematolojik hastalıklar nedeniyle splenektomi yapılan 48 hastanın 30'unda komplikasyonlar görüldü. Kronik ITP hastalığı nedeniyle opere edilen 29 hastanın 17'sinde, İTP hastalarının tümünde yani 5 hastada, hemolitik anemili hastalarının tümünde yani 2 hastada komplikasyonlar görüldü. Çalışmaya alınan 4 hastada yara enfeksiyonu, 3 hastada intestinal obstruksiyon, 1 hastada septisemi, 2 hastada splenik yatakta hematom, 20 hastada sol plevral efffüzyon saptandı. Hastanede takip edilen süre içerisinde hastaların hiçbirinde mortalite saptanmadı. Sonuç olarak bizim çalışmamızda literatüre benzer biçimde splenektomi mortalite açısından güvenli bir yöntem olarak saptanmıştır. Morbidite açısından literatürdeki çalışmalara benzer şekilde en sık olarak sol plevral efüzyon saptanmış; bu durum en sık kronik İTP hastalarında görülmüştür.
Hypersplenism is encountered in many hematologic diseases and syndromes. Splenectomy is performed for Hypersplenism, splenic trauma and staging of hematological malignancy. In this retrospective study, we aimed to analyze 48 patients undergone Splenectomy for hematological diseases between 1st January 2005 and 1st November 2008 at Dicle University Hospital Department of General Surgery. Datas were evaluated for post operative complications. In the study, 21 male and 27 women with the mean age of 36.65 ± 15.58 years. All patients undergone Splenectomy and diagnosis of hematological diseases chronic idiopathic thrombocytopenic purpura (chronic ITP) in 29 patients, idiopathic thrombocytopenic purpura (ITP) in 5, lymphoma in 5, hereditary spherocytosis in 3, hematolitic anemia in 2 and chronic lymphoblastic lymphoma in one, thalesemia major in one, myelofibrosis in one patient and thalesemia intermediary in one patient. The mean hospital staying time was 7.31 ± 3.45 days. Longest staying time was encountered in hemolytic anemia with 22 days, followed with 17 days in myelofibrosis and 12 days in chronic idiopathic thrombocytopenic purpura, lymphoma, thalesemia intermediary. When we accept the average size of spleen 80-120 mm, bigger sizes of spleen were noticed in hereditary spherocytosis, chronic idiopathic thrombocytopenic purpura, lymphoma, myelofibrosis and thalesemia major. Eleven patients had preoperative blood transfusion and 14 had postoperative blood transfusion. Complications were developed in 30 patients among 48 operated patients. Complications were noticed in 17 patients among 29 chronic ITP, in all 5 ITP, in all 2 hemolytic anemia. Postoperative complications were wound infection in 4 patients, intestinal obstruction in 3, septicemia in one, hematomas in Splenectomy area in 2, left pleural effusion in 20 patients. None of the patients died during follow up time. In this study, Similar to surgical literature, we arrived to conclusion that Splenectomy could be performed safely in hematologic diseases. Left pleural effusion was the most common complication and mostly encountered in chronic ITP.
Hypersplenism is encountered in many hematologic diseases and syndromes. Splenectomy is performed for Hypersplenism, splenic trauma and staging of hematological malignancy. In this retrospective study, we aimed to analyze 48 patients undergone Splenectomy for hematological diseases between 1st January 2005 and 1st November 2008 at Dicle University Hospital Department of General Surgery. Datas were evaluated for post operative complications. In the study, 21 male and 27 women with the mean age of 36.65 ± 15.58 years. All patients undergone Splenectomy and diagnosis of hematological diseases chronic idiopathic thrombocytopenic purpura (chronic ITP) in 29 patients, idiopathic thrombocytopenic purpura (ITP) in 5, lymphoma in 5, hereditary spherocytosis in 3, hematolitic anemia in 2 and chronic lymphoblastic lymphoma in one, thalesemia major in one, myelofibrosis in one patient and thalesemia intermediary in one patient. The mean hospital staying time was 7.31 ± 3.45 days. Longest staying time was encountered in hemolytic anemia with 22 days, followed with 17 days in myelofibrosis and 12 days in chronic idiopathic thrombocytopenic purpura, lymphoma, thalesemia intermediary. When we accept the average size of spleen 80-120 mm, bigger sizes of spleen were noticed in hereditary spherocytosis, chronic idiopathic thrombocytopenic purpura, lymphoma, myelofibrosis and thalesemia major. Eleven patients had preoperative blood transfusion and 14 had postoperative blood transfusion. Complications were developed in 30 patients among 48 operated patients. Complications were noticed in 17 patients among 29 chronic ITP, in all 5 ITP, in all 2 hemolytic anemia. Postoperative complications were wound infection in 4 patients, intestinal obstruction in 3, septicemia in one, hematomas in Splenectomy area in 2, left pleural effusion in 20 patients. None of the patients died during follow up time. In this study, Similar to surgical literature, we arrived to conclusion that Splenectomy could be performed safely in hematologic diseases. Left pleural effusion was the most common complication and mostly encountered in chronic ITP.
Açıklama
Anahtar Kelimeler
Hematoloji, Hematology, Genel Cerrahi, General Surgery
