Perkütan Nefrolitotomide Renal Dilatasyon Yöntemlerinin Sonuç ve Komplikasyonlar Üzerine Etkisi

Öz

Giriş/Amaç:Perkütan nefrolitotomide kullanılan iki farklı renal dilatasyon yönteminin taşsızlık oranları ve komplikasyonlar üzerine olan etkilerini karşılaştırmayı amaçladık. Gereç ve Yöntemler:Haziran 2013-Aralık 2018 tarihleri arasında iki ayrı merkezde, renal pelvis ve kaliks taşları nedeni ile perkütan nefrolitotomi uygulanan hastaların verileri retrospektif olarak değerlendirildi. Tüm hastaların, komorbid hastalıkları, geçirilmiş taş cerrahisi öyküleri, yaş gibi demografik özelliklerinin yanı sıra taş tarafı, taş sayısı ve taş yükü, Hounsfield Unit değeri ve hidronefroz derecesi kaydedildi. Hastalar, kullanılan dilatasyon yöntemine göre balon dilatasyon (Grup 1), amplatz seri dilatasyon (Grup 2) ve kombine (Grup 3) olmak üzere 3 gruba ayrıldı. Operasyon süreleri, postoperatif hemoglobin düşüşü, transfüzyon gereksinimi, taşsızlık oranı, hastanede kalış ve nefrostomi alınma süreleri ile komplikasyon oranları gruplar arasında karşılaştırıldı. Bulgular:Gruplar arasında ortalama operasyon süreleri (p=0,185), taşsızlık oranları (p=0,313) ve komplikasyonlar (p=0,053) açısından istatistiki anlamlı fark izlenmedi. Postoperatif hemoglobin ve hematokrit düşüşü en fazla grup 3 hastalarda gözlendi. Grup 1 ve grup 2 hastalar arasında ise anlamlı fark yoktu (p=0,373). Benzer şekilde grup 1 hastalarda, grup 2’ye göre daha fazla transfüzyon ihtiyacı saptansa da anlamlı fark izlenmedi (p=0,787). Hastanede kalış ve nefrostomi alınma süresi ise grup 1’de anlamlı derecede daha kısa saptandı (p<0,05). Sonuç:Amplatz seri dilatatörler, komplikasyon ve taşsızlık oranları bakımından balon dilatatörlere benzer sonuçlar sunmaktadır.

Anahtar Kelimeler

• Perkütan nefrolitotomi
• Balon dilatatör
• Amplatz Seri Dilatatör
• Perkütan renal giriş
• Komplikasyon

Efficacy of Renal Dilatation Methods on Results and Complications in Percutaneous Nephrolithotomy

Abstract

Objective:We aimed to compare the effects of two different renal dilatation methods used in percutaneous nephrolithotomy on stone-free rates and complications. Methods:In two centers between June 2013 and December 2018, the data of patients who underwent percutaneous nephrolithotomy for renal pelvis and calyceal stones were retrospectively evaluated. Stone side, stone number and stone burden, Hounsfield Unit value and degree of hydronephrosis were recorded as well as demographic characteristics of all patients such as comorbid diseases, history of previous stone surgery, age. The patients were divided into 3 groups according to the dilatation method used: balloon dilatation (Group 1), amplatz serial dilatation (Group 2) and combined (Group 3). Operation times, postoperative hemoglobin decrease, transfusion requirement, stone-free rate, hospital stay, time of nephrostomy and complication rates were compared between the groups. Results:There was no difference between the groups in terms of mean operation times (p=0,185), stone-free rates (p=0,313) and complications (p=0,053). Postoperative hemoglobin and hematocrit decrease was mostly observed in group 3 patients. There was no significant difference between group 1 and group 2 patients (p = 0.373). Similarly, although the transfusion requirement was higher in group 1 patients compared to group 2, no significant difference was observed (p=0,787). The duration of hospital stay and nephrostomy removal time were significantly shorter in group 1 (p<0,005). Conclusion:Amplatz series dilators offer similar results to balloon dilators in terms of complication and stone-free rates.

Keywords

• Percutaneous nephrolithotomy
• Balloon dilator
• Amplatz serial dilator
• Percutaneous renal Access
• Complication.

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