Skip to main content
SpringerLink
Log in

Splenektomie bei idiopathischer thrombozytopenischer Purpura

Retrospektive Analyse des postoperativen Verlaufs

Splenectomy for thrombocytopenic purpura

Retrospective analysis of the postoperative course

  • Originalien
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die idiopathische thrombozytopenische Purpura (ITP) macht etwa 8% aller hämorrhagischen Diathesen aus. Therapeutisch sind eine medikamentöse Therapie sowie die Splenektomie etablierte Behandlungsverfahren. Die chirurgische Intervention ist insbesondere nach Versagen der konservativen Therapie häufig die ultima ratio.

Patienten und Methoden

Bei 47 bzw. 33 splenektomierten Patienten mit ITP, die zuvor eine medikamentöse Therapie mit verschiedenen Wirkstoffen durchliefen, verfolgten wir sowohl die unmittelbar postoperative Entwicklung der Thrombozytenzahlen als auch den Langzeitverlauf über einen Zeitraum von bis zu 9 Jahren.

Ergebnisse

Unmittelbar postoperativ erreichten über 75% der Patienten Thrombozytenzahlen im normalen oder hochnormalen Bereich. In der Langzeituntersuchung zeigte sich, dass 58% der Patienten dauerhaft von der Splenektomie profitierten. Weitere 29% der Patienten zeigten eine Stabilisierung der Erkrankung.

Schlussfolgerung

Die ITP ist eine chirurgisch zu therapierende Erkrankung, bei der ein hoher Heilungserfolg zu erzielen ist. Faktoren, die die postoperative Entwicklung der Erkrankung abschätzen lassen, sind noch nicht sicher identifiziert und müssen in Zukunft noch genauer untersucht werden.

Abstract

Background

Idiopathic thrombocytopenic purpura (ITP) comprises approximately 8% of all haemorrhagic diseases. Typical findings are a very low platelet count which manifests as petechial bleeding. Therapy consists of medication and removal of the spleen if conservative therapy fails.

Patients and methods

Between 1988 and 1999, 47 patients with ITP were splenectomized in our surgical department. We examine the postoperative development of platelet counts and long-term results in 33 of these patients.

Results

After splenectomy, more then 75% of our patients had normal platelet counts. In long-term examination, 58% remained in stable condition with normal platelet counts. Retrospectively we tried to identify preoperative clinical features that could predict the long-term outcome of splenectomy in ITP but were unable to find reliable factors.

Conclusion

Idiopathic thrombocytopenic purpura can be treated by surgical means but should be considered only when conservative treatment has failed. The long-term outcome of splenectomy is not predictable. Reliable predictive factors have to be identified through further research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Akwari O, Itani M (1987) Splenectomy for primary and recurrent ITP. Ann Surg 206:529–541

    Google Scholar 

  2. Ben-Yehuda D, Gillis S (1994) Clinical and therapeutic experience in 712 Israeli patients with idiopathic thrombocytopenic purpura. Acta Haematol 91:1–6

    Google Scholar 

  3. Davidson RN, Wall RA (2001) Prevention and management of infections in patients without a spleen. Clin Microbiol Infect 7:657–660

    Article  Google Scholar 

  4. Delaitre (2002) Laparoscopic splenectomy für idiopathic thrombocytopenic pupura. Surg Laparosc Endosc Percutan Tech 12 (6):412–419

    Article  Google Scholar 

  5. Deutsch E, Bruhn HD (1994) Störungen der Hämostase und Hämorrhagische Diathesen. In: Innere Medizin, Gross, Schölmerich & Gerok, S 132 ff

  6. Duperier T, Brody F, Felsher J, Walsh RM, Rosen M, Ponsky J (2004) Predictive factors for successful laparoscopic splenectomy in patients with immune thrombocytopenic purpura. Arch Surg 139 (1):61–66

    Article  Google Scholar 

  7. Eber (2001) Infektionsprophylaxe bei Asplenie. Klin Padiatr 213:84–87

    Article  Google Scholar 

  8. Fabris F, Zanatta N (1989) Response to splenectomy in idiopathic thrombocytopenic purpura: prognostic value of the clinical and laboratory evaluation. Acta Haematol 81:28–33

    Google Scholar 

  9. Friedman R, Hiatt J (1997) Laparoscopic or open splenectomy for hematologic disease: which approach is superior? J Am Coll Surg 185:49–54

    Article  Google Scholar 

  10. Gadenstätter et al. (2002) Splenectomy versus medical treatment for idiopathic thrombocytopenic purpura. Am J Surg 184:606–610

    Article  Google Scholar 

  11. George et al. (1996) Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood 88:3–40

    Google Scholar 

  12. George J, El-Harake M (1995) Thrombocytopenia due to enhanced platelet destruction by immunologic mechanisms. In: Williams Hematology, Part X. New York, S 1315–1355

  13. Germing U, Simons B, MacKenzie C (2003) Infektionsprophylaxe bei asplenischen Patienten: Grundlage und Empfehlungen. Impf Dialog 4:166–174

    Google Scholar 

  14. Gunsilius E, Seiffried F (1993) Therapie der Autoimmunthrombozytopenie des Erwachsenen. Infusionsther & Transfusionsmed 20 [Supp 1]:87–98

  15. Holt (2003) Response to intravenous immunoglobulin predicts splenectomy response in children with immune thrombocytopenic purpura. Pediatrics 111:87–90

    Google Scholar 

  16. Katkhouda et al. (2001) Predictors of response after laparoscopic splenectomy for immune thrombocytopenic purpura. Surg Endosc 15 (5):484–488

    Article  CAS  PubMed  Google Scholar 

  17. Law (1997) High-Dose intravenous imune globulin and the response to splenectomy in patients with idiopathic thrombocytopenic purpura. New Eng J Med 336:1494–1499

    Article  Google Scholar 

  18. Marble K, Deckers P (1993) Changing role of splenectomy for hematologic disease. J Surg Oncol 52:169–171

    Google Scholar 

  19. Maslanka K, Sikorska A, Misiak A, Konopka L, Zupanska B (2004) Long-term outcome of splenectomy for immune thrombocytopenic purpura. Am J Hematol 75 (2):117–118

    Article  Google Scholar 

  20. Mazzuconi MG, Arista MC (1999) Long-term follow-up of autoimmune thrombocytopenic purpura (ATP) patients submitted to splenectomy. Eur J Haematol 62:219–222

    Google Scholar 

  21. Mesa RA, Tefferi A (2001) Palliative splenectomy in myelofibrosis with myeloid metaplasia. Leuk Lymphoma 42:901–911

    Google Scholar 

  22. Pace et al. (2003) Laparoscopic splenectomy for idiopathic thrombocytopenic pupura (ITP). Surg Endosc 17 (1):95–98

    Article  Google Scholar 

  23. Pizzuto J, Ambriz R (1984) Therapeutic experience on 934 adults with ITP: multicentric trial of the Cooperative Latin American Group. Blood 64:1179–1183

    CAS  PubMed  Google Scholar 

  24. Schneider W (1989) Thrombozytopenie als diagnostisches und therapeutisches Problem. Sonderdruck, Edition Sandoz

  25. Shanafelt (2003) Rituximab for immune cytopenia in adults: idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia and Evans Syndrome. Mayo Clin Proc 78:1340–1346

    CAS  PubMed  Google Scholar 

  26. Stasi R, Provan D (2004) Management of immune thrombocytopenic purpura in adults. Mayo Clin Proc 79 (4):504–522

    Google Scholar 

  27. Szold et al. (2002) Chronic idiopathic thrombocytopenic purpura (ITP) is a surgical disease. Surg Endosc 16 (1):155–158

    Article  Google Scholar 

  28. Tsereteli et al. (2001) Are the favorable outcomes of splenectomy predictable in patients with idiopathic thrombocytopenic purpura (ITP)? Surg Endosc 15 (12):1386–1389

    CAS  PubMed  Google Scholar 

  29. Williams JA, Boxer LA (2003) Combination therapy for refractory idiopathic thrombocytopenic purpura in adolescents. J Pediatr Hematol Oncol 25 (3):232–235

    Article  Google Scholar 

  30. Yang et al. (2000) Pathogenesis and management of chronic ITP: an update. Int J Hematol 71:18–24

    Article  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Neurochirurgie, Universitätsklinikum Düsseldorf

    K. Beseoglu

  2. Klinik für Hämatologie, Onkologie und klinische Immunologie, Universitätsklinikum Düsseldorf

    U. Germing

  3. Klinik für Allgemeine-, Virzeral- und Unfallchirurgie, St. Elisabeth-Krankenhaus Dorsten

    W. Gross-Weege

  4. Neurochirurgie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225 , Düsseldorf

    K. Beseoglu

Authors
  1. K. Beseoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. U. Germing
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Gross-Weege
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Beseoglu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Beseoglu, K., Germing, U. & Gross-Weege, W. Splenektomie bei idiopathischer thrombozytopenischer Purpura. Chirurg 76, 769–776 (2005). https://doi.org/10.1007/s00104-004-0998-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-004-0998-2

Schlüsselwörter

Keywords

Search

Navigation