Tratamento minimamente invasivo em pacientes com púrpura trombocitopenica imunológica
esplenectomia por uma técnica minilaparoscópica híbrida
DOI:
https://doi.org/10.11606/issn.1679-9836.v99i1p76-79Palavras-chave:
Laparoscopia, Esplenectomia, Cirurgia geral, Púrpura trombocitopênicaResumo
Duas pacientes, uma com 28 anos e outro com 61 anos de idade, apresentavam quadro de astenia, púrpura e trombocitopenia (ambos < 15.000 plaquetas/mm3). Após a exclusão de outras etiologias e com o estabelecimento do diagnóstico de púrpura trombocitopênica imunológica (PTI), ambos iniciaram terapia com corticoides. Entretanto, ambos pacientes permaneceram com plaquetas < 20.000 /mm3, caracterizando PTI refratária e com a indicação de esplenectomia. A equipe cirúrgica optou por uma abordagem minilaparoscópica híbrida. Com uma melhor visualização do campo cirúrgico, menos trauma abdominal, mais destreza nos movimentos e com alta hospitalar precoce, o uso de instrumentos minilaparoscópicos se provou uma abordagem segura e eficaz para esses pacientes.
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Referências
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5. Carvalho GL, GÓes GHB, Cordeiro RN, Lima DL, Amorim LLL, Furtado RHM. A new hybrid mini-laparoscopic technique for Spigelian hernia. J Minim Access Surg. 2018;15(3):253-255. doi: 10.4103/jmas.JMAS_179_18.
6. Tada K, Ohta M, Saga K, Takayama H, Hirashita T, Endo Y, et al. Long-term outcomes of laparoscopic versus open splenectomy for immune thrombocytopenia. Surg Today. 2018;48(2):180-5. doi: 10.1007/s00595-017-1570-2.
7. Backus CL, Park AE, Matthews BD, Heniford BT. Mini-laparoscopic splenectomy. J Laparoendosc Adv Surg Tech A. 2000;10(5):259-62. doi: 10.1089/lap.2000.10.259.
8. Sadamoto Y, Abe Y, Kato K, Nishimura J. Partial splenic embolization as a preoperative treatment for refractory idiopathic thrombocytopenic purpura [abstract]. Rinsho Ketsueki. 1998;39(12):1194-6.
9. Baú PC, Cavazolla SA, Souza HP, Garicochea B. Preoperative embolization of the splenic artery in patients that underwent splenectomy for immune thrombocytopenic purpura. Acta Cir Bras. 2007;22(6):470-3. doi: 10.1590/S0102-86502007000600010.
10. Lee P-C, Lai I-R, Yu S-C. Minilaparoscopic (needlescopic) cholecystectomy: a study of 1,011 cases. Surg Endosc. 2004;18(10):1480-4. doi: 10.1007/s00464-003-8247-1.
11. Suo G, Xu A. Clipless minilaparoscopic cholecystectomy: a study of 1,096 cases. J Laparoendosc Adv Surg Tech A. 2013;23(10):849-54. doi: 10.1089/lap.2012.0561.
12. Malcher F, Cavazzola LT, Carvalho GL, Araujo GDE, Silva JADCE, Rao P, et al. Minilaparoscopy For Inguinal Hernia Repair. JSLS. 2016;20(4):pii: e2016.00066. doi: 10.4293/JSLS.2016.00066.
13. Carvalho GL, Loureiro MP, Bonin EA, Claus CP, Silva FW, Cury AM, et al. Minilaparoscopic technique for inguinal hernia repair combining transabdominal pre-peritoneal and totally extraperitoneal approaches. JSLS. 2012;16(4):569-75. doi: 10.4293/108680812X13462882737096.
14. McCloy R, Randall D, Schug SA, Kehlet H, Simanski C, Bonnet F, et al. Is smaller necessarily better? A systematic review comparing the effects of minilaparoscopic and conventional laparoscopic cholecystectomy on patient outcomes. Surg Endosc. 2008;22(12):2541-53. doi: 10.1007/s00464-008-0055-1.
15. Sajid MS, Khan MA, Ray K, Cheek E, Baig MK. Needlescopic versus laparoscopic cholecystectomy: a meta-analysis. ANZ J Surg. 2009;79(6):437-42. doi: 10.1111/j.1445-2197.2009.04945.x.
16. Gurusamy KS, Vaughan J, Ramamoorthy R, Fusai G, Davidson BR. Miniports versus standard ports for laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2013;(8):CD006804. doi: 10.1002/14651858.CD006804.pub3.
17. Carvalho GL, Abreu GFS, Lima DL, Góes GHB Type IV Mirizzi syndrome treated with hepaticoduodenostomy and minilaparoscopy. CRSLS e2016. 00057. Available from: http://crsls.sls.org/wp-content/uploads/2016/08/jls103163579001.pdf.
18. de Carvalho GL, de Góes GHB, Furtado RHM, Cordeiro RN, Araújo Lessa M de C. Resection of a giant nonparasitic splenic cyst by minilaparoscopy. J Minim Access Surg. 2019;15(1):71-3. doi: 10.4103/jmas.JMAS_55_18.
19. Carvalho GL, Góes GHB, Furtado RHM, Cordeiro RN, Calheiros EMQ. Resection of giant hepatic cyst by hybrid minilaparoscopy. J Minim Access Surg. 2019;15(2):167-9. doi: 10.4103/jmas.JMAS_68_18.
2. Sakamoto K, Nakasone H, Tsurumi S, Sasaki K, Mitani K, Kida M, et al. Prednisone versus high-dose dexamethasone for untreated primary immune thrombocytopenia. A retrospective study of the Japan Hematology & Oncology Clinical Study Group. J Thromb Thrombolysis. 2014;37(3):279-86. doi: 10.1007/s11239-013-0939-3.
3. Qu Y, Xu J, Jiao C, Cheng Z, Ren S. Long-term outcomes of laparoscopic splenectomy versus open splenectomy for idiopathic thrombocytopenic purpura. Int Surg. 2014;99(3):286-90. doi: 10.9738/INTSURG-D-13-00175.1.
4. Firme WA, Carvalho GL, Lima DL, Lopes VG de P, Montandon ID, Santos Filho F, et al. Low-friction minilaparoscopy outperforms regular 5-mm and 3-mm instruments for precise tasks. JSLS. 2015;19(3). doi: 10.4293/JSLS.2015.00067.
5. Carvalho GL, GÓes GHB, Cordeiro RN, Lima DL, Amorim LLL, Furtado RHM. A new hybrid mini-laparoscopic technique for Spigelian hernia. J Minim Access Surg. 2018;15(3):253-255. doi: 10.4103/jmas.JMAS_179_18.
6. Tada K, Ohta M, Saga K, Takayama H, Hirashita T, Endo Y, et al. Long-term outcomes of laparoscopic versus open splenectomy for immune thrombocytopenia. Surg Today. 2018;48(2):180-5. doi: 10.1007/s00595-017-1570-2.
7. Backus CL, Park AE, Matthews BD, Heniford BT. Mini-laparoscopic splenectomy. J Laparoendosc Adv Surg Tech A. 2000;10(5):259-62. doi: 10.1089/lap.2000.10.259.
8. Sadamoto Y, Abe Y, Kato K, Nishimura J. Partial splenic embolization as a preoperative treatment for refractory idiopathic thrombocytopenic purpura [abstract]. Rinsho Ketsueki. 1998;39(12):1194-6.
9. Baú PC, Cavazolla SA, Souza HP, Garicochea B. Preoperative embolization of the splenic artery in patients that underwent splenectomy for immune thrombocytopenic purpura. Acta Cir Bras. 2007;22(6):470-3. doi: 10.1590/S0102-86502007000600010.
10. Lee P-C, Lai I-R, Yu S-C. Minilaparoscopic (needlescopic) cholecystectomy: a study of 1,011 cases. Surg Endosc. 2004;18(10):1480-4. doi: 10.1007/s00464-003-8247-1.
11. Suo G, Xu A. Clipless minilaparoscopic cholecystectomy: a study of 1,096 cases. J Laparoendosc Adv Surg Tech A. 2013;23(10):849-54. doi: 10.1089/lap.2012.0561.
12. Malcher F, Cavazzola LT, Carvalho GL, Araujo GDE, Silva JADCE, Rao P, et al. Minilaparoscopy For Inguinal Hernia Repair. JSLS. 2016;20(4):pii: e2016.00066. doi: 10.4293/JSLS.2016.00066.
13. Carvalho GL, Loureiro MP, Bonin EA, Claus CP, Silva FW, Cury AM, et al. Minilaparoscopic technique for inguinal hernia repair combining transabdominal pre-peritoneal and totally extraperitoneal approaches. JSLS. 2012;16(4):569-75. doi: 10.4293/108680812X13462882737096.
14. McCloy R, Randall D, Schug SA, Kehlet H, Simanski C, Bonnet F, et al. Is smaller necessarily better? A systematic review comparing the effects of minilaparoscopic and conventional laparoscopic cholecystectomy on patient outcomes. Surg Endosc. 2008;22(12):2541-53. doi: 10.1007/s00464-008-0055-1.
15. Sajid MS, Khan MA, Ray K, Cheek E, Baig MK. Needlescopic versus laparoscopic cholecystectomy: a meta-analysis. ANZ J Surg. 2009;79(6):437-42. doi: 10.1111/j.1445-2197.2009.04945.x.
16. Gurusamy KS, Vaughan J, Ramamoorthy R, Fusai G, Davidson BR. Miniports versus standard ports for laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2013;(8):CD006804. doi: 10.1002/14651858.CD006804.pub3.
17. Carvalho GL, Abreu GFS, Lima DL, Góes GHB Type IV Mirizzi syndrome treated with hepaticoduodenostomy and minilaparoscopy. CRSLS e2016. 00057. Available from: http://crsls.sls.org/wp-content/uploads/2016/08/jls103163579001.pdf.
18. de Carvalho GL, de Góes GHB, Furtado RHM, Cordeiro RN, Araújo Lessa M de C. Resection of a giant nonparasitic splenic cyst by minilaparoscopy. J Minim Access Surg. 2019;15(1):71-3. doi: 10.4103/jmas.JMAS_55_18.
19. Carvalho GL, Góes GHB, Furtado RHM, Cordeiro RN, Calheiros EMQ. Resection of giant hepatic cyst by hybrid minilaparoscopy. J Minim Access Surg. 2019;15(2):167-9. doi: 10.4103/jmas.JMAS_68_18.
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Publicado
2020-02-03
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Seção
Relato de Caso/Case Report
Como Citar
Carvalho, G. L. de, Lima, D. L., Cordeiro, R. N., Góes, G. H. B. de, & Lessa, M. C. A. (2020). Tratamento minimamente invasivo em pacientes com púrpura trombocitopenica imunológica: esplenectomia por uma técnica minilaparoscópica híbrida. Revista De Medicina, 99(1), 76-79. https://doi.org/10.11606/issn.1679-9836.v99i1p76-79
