Valmiltistökur á Landspítala 1993-2004 : árangur og langtímaeftirfylgd

Objective: To evaluate the long-term outcome of elective splenectomy, with emphasis on the incidence of complications, vaccine immunization and patient´s knowledge about asplenia. Material and methods: Medical reports of all patients, who underwent elective splenectomy during the time period of 1993-2004, were reviewed. Questionnaire was sent to 96% (44/46) patients alive. Results: The average age was 50 (8-83) years. Thirty-five patients were male and 32 were female. Eighty percent responded to the questionnaire. Most of the patients (31) had idiopathic thrombocytopenic purpura (ITP). Complete response was obtained in 60% (18/30) and partial response in 23% (7/30). Five patients had spherocytosis and all of them had complete response. None of the three patients with autoimmune hemolytic anemia had any response to the splenectomy. Patients were vaccinated against pneumococci in 92% of the cases. In 44% of the cases revaccination was done. Only 41% of those who answered experienced that they had got a good education about the consequences of asplenia. Sixteen percent of the patients (10/64) had major postoperative complications. One patient with metastatic cancer and thrombocytopenia died within 30 days of surgery. Five patients had long-term complications. Two had pneumococcal sepsis, one of them was unvaccinated and the other had not been revaccinated. Conclusion: Splenectomy has a good long-term outcome for spherocytosis and ITP patients. The incidence of complications is high. It is possible that better guidelines and better patient´s education can lower the complication rate and improve the outcome.
Tilgangur: Meta árangur valmiltistöku í meðferð blóðsjúkdóma. Meta tíðni fylgikvilla og kanna hvernig fræðslu og bólusetningum er háttað. Efniviður og aðferðir: Farið var yfir sjúkraskrár þeirra 67 sjúklinga sem gengust undir valmiltistöku á árunum 1993-2004. Spurningalistar voru sendir til 96% (44/46) núlifandi sjúklinga, tveir fengu ekki spurningalista vegna búsetu erlendis. Niðurstöður: Meðalaldur við aðgerð var 50 (8-83) ár. Karlar voru 35 og konur 32. Svörun spurningalista var 80%. Flestir sjúklinganna (31) voru með sjálfvakta blóðflögufæð (idiopathic thrombocytopenic purpura). Sextíu prósent þeirra fengu fullan bata og 23% nokkurn bata. Fimm sjúklingar voru með hnattrauðkornablóðleysi (spherocytosis) og skilaði miltistaka fullum árangri hjá þeim öllum. Þrír sjúklingar voru með sjálfnæmisblóðleysi (autoimmune hemolytic anemia) en enginn þeirra hlaut bata. Bólusett var gegn pneumókokkum í 92% tilvika. Endurbólusetning fór fram hjá 44%. Einungis 41% töldu sig hafa fengið góða fræðslu um fylgikvilla miltisleysis. Alvarlegir bráðir fylgikvillar komu fram hjá 16% (10/64) sjúklinga. Einn sjúklingur með útbreitt krabbamein og blóðflögufæð lést innan 30 daga eftir aðgerð. Fimm sjúklingar fengu síðkomna fylgikvilla. Tveir fengu pneumókokkasýklasótt, annar var ekki bólusettur og hinn hafði ekki fengið endurbólusetningu á tilskildum tíma. Ályktun: Miltistaka skilar góðum langtímaárangri hjá sjúklingum með blóðdílasótt og hnattrauðkornakvilla. Tíðni fylgikvilla er há. Vinnureglur um undirbúning, bólusetningar, eftirfylgd og fræðslu sjúklinga gætu fækkað fylgikvillum og bætt útkomu.