Hematolojik hastalıklarda splenektomi; tek merkez deneyimi

Splenektomi, medikal tedaviye direncli ve agresif seyreden hematolojik hastaliklarda onemli bir tedavi secenegidir. Diger yandan bir kisim hematolojik hastaliklarda ise tani amaciyla splenektomi yapilir. Bu calismada, klinigimizde hematolojik nedenlerle tani veya tedavi amacli splenektomi yapilan hastalari ve sonuclarini sunmayi amacladik. Bu calismada Eylul 2005 ile Mayis 2011 tarihleri arasinda Ondokuz Mayis Universitesi Tip Fakultesinde splenektomi yapilan 184 hasta retrospektif olarak incelendi. Calismaya Hematoloji poliklinigine basvuru yapan ve hematolojik hastaligi nedeniyle splenektomi yapilan 54 hasta dahil edildi. Hastalarin 34’u (%63) kadin, 20’si (%37) erkek idi. Yas ortalamasi 43,9±16,9 idi. En sik splenektomi yapilan hematolojik hastalik immun trombositopenik purpura (ITP) (%70,4) idi. 53 hastada tedavi ve bir hastada tanisal amacli splenektomi yapilmisti. Tanisal amacli splenektomi yapilan hastada patoloji sonucu Hodgkin lenfoma idi. Hastalarin en sik on plana cikan semptomlari cilt lezyonlari idi (petesi, purpura, ekimoz). Hastalarin dalak boyutu degerlendirildiginde 38 (%70,4) hastanin dalak boyutlari normaldi. ITP tanili hastalarin 35’inde (%92,1) dalak boyutu normal sinirlarda bulundu. Hastalarin 16’sinda (%29,6) hepatomegali saptandi. Ameliyat sirasinda %13 hastada aksesuar dalak tespit edildi. En sik bildirilen dalak patoloji sonucu hipersplenizm idi. 46 hastaya ameliyat oncesi, 16 hastaya ise ameliyat sonrasi pnomokok ve hemofilus influenza asilari yapilmisti. Meningokok asisi temin edilemediginden yapilamadigi tespit edildi. Cerrahi komplikasyonlara bagli olum izlenmedi. Sonuc olarak splenektomi hematolojik hastalarda tani ve tedavide guncelligini korumaktadir. Yeni tani ve tedavi yontemlerinin gelismesiyle bir kisim hematolojik hastaliklarda splenektomi sikliginin azalacagi kanaatindeyiz. Bununla birlikte konu ile ilgili yapilacak olan cok merkezli ve genis vaka serili yayinlara ihtiyac vardir. Splenectomy in haematological diseases; single center experience Splenectomy is an important treatment option in some haematologic diseases which are aggressive and refractory to medical treatment. Splenectomy is also used for diagnosis for some of the hematologic diseases. In this study, we aimed to present the patients and the results of the diagnostic and therapeutic splenectomy due to haematologic diseases. In this study, between September 2005 and May 2011, in Ondokuz Mayis University Faculty of Medicine, 184 patients with splenectomy were retrospectively reviewed. Fifty four patients were included who applied to Haematology Clinic and had splenectomy due to haematological diseases. 34 (63%) of patients were female and 37% (20) were male. The mean age was 43.93±16.9. The most common haematologic disease for which splenectomy was immune thrombocytopenic purpura (ITP) (70.4%). Splenectomy was applied for therapeutic purpose in 53 patients and for diagnostic purpose in 1 patient. The pathology result was Hodgkin lymphoma in the patient who receieved diagnostic splenoctomy. The most common presenting symptoms of the patients were skin lesions (petechiae, purpura, ecchymosis). Spleen size had within the normal range in 38 (70.4%) patients. Normal spleen size was observed in 35 ITP patients (92.1%) . 16 patients (29.6%) had hepatomegaly. Accessory spleen was found in 13% of patients during surgery. The most frequently reported result of splenic pathology was found to be hypersplenism. 46 patients before surgery, 16 patients after the surgery had pneumococcal and haemophilus influenza vaccines. Meningococcal vaccine could not be done because it could not be obtained. Death due to surgical complications was not observed. As a result, splenectomy, is still used for diagnosis and treatment in hematological diseases, at diagnosis and treatment remains up to date. The development of new diagnostic and treatment methods would decrease the frequency of splenectomy in some hematologic diseases. However, large multi-center case-serial publications will be needed. J. Exp. Clin. Med., 2012; 29: 276-279