Pediatrik perkütan nefrolitotomide tek aşamalı dilatasyon tekniği, aşamalı dilatasyona efektif bir alternatif olabilir mi?

Abstract

Amaç: Büyük ve kompleks böbrek taşlarının tedavisinde etkili ve güvenilir bir yöntem olan perkütan nefrolitotomi (PNL) ameliyatının en önemli aşaması akses sağlandıktan sonra uygun ve efektif bir traktusun oluşturulmasıdır. Bu amaçla Amplatz, balon ve Alken dilatatörler gibi farklı teknikler tariflenmiştir. Biz pediatrik PNL ameliyatlarında single step Amplatz dilatasyon tekniğinin etkinlik ve güvenilirliğini aşamalı Amplatz dilatasyon tekniği yapılan hastalar ile karşılaştırmayı amaçladık.

Yöntemler: Bu çalışma retrospektif kohort çalışmasıdır. Son on yılda merkezimizde 72 pediatrik hastaya uygulanan 75 PNL ameliyatının verileri değerlendirildi. Single step dilatasyon tekniği (Grup 1, n:41) ile aşamalı dilatasyon tekniği (Grup 2. n:34) yapılan hastaların floroskopi ve cerrahi süreleri, taşsızlık ve komplikasyon oranları, ameliyat öncesi ve sonrası hematokrit seviyeleri ile kan transfüzyon oranları karşılaştırıldı. 

Bulgular: Gruplar arasında hastaların demografik verileri, ortalama taş yükü, operasyon süresi, hematokritte azalma, kan transfüzyonu ihtiyacı, taşsızlık oranı ve komplikasyon oranları açısından anlamlı farklılık görülmedi. Grup 1 ve Grup 2 medyan floroskopi süreleri sırasıyla 120 ve 220 saniye olarak saptandı. Single step dilatasyon grubunda ameliyat ve floroskopi süreleri anlamlı olarak daha kısa olduğu saptandı. 

Sonuç: PNL, çocuk taş hastalıklarında uygulanan güvenli ve etkili bir prosedürdür. Bu prosedürün tek adımlı dilatasyon tekniği ile yapılması çocuk hastaların daha az radyasyona maruz kalmasını sağlamaktadır.

Keywords

• Tek aşamalı dilatasyon,Böbrek taşı,Perkutan nefrolitotomi,Floroskopi

Can single-step dilatation technique in pediatric percutaneous nephrolithotomy be an effective alternative to stepwise dilatation?

Abstract

Aim: The most important stage of percutaneous nephrolithotomy (PNL), which is an effective and reliable method in the treatment of large and complex kidney stones, is to create a suitable and effective tract after the accessory is provided. For this purpose, different techniques such as Amplatz, baloon and Alken dilators have been described. We aimed to compare the efficacy and safety of single-step Amplatz dilatation technique with stepwise Amplatz dilatation technique in pediatric PNL patients.

Methods: This is a retrospective cohort study. We evaluated the data from 75 PNL operations performed on 72 pediatric patients in our center within the last decade. The data from single-step dilation technique patient group (group 1, n: 41) and the stepwise dilatation technique patient group (group 2, n: 34) was compared in terms of durations of fluoroscopy and surgery, stone-free and complication rates, pre and postoperative hematocrit levels and blood transfusions rates. 

Results: There was no significant difference between the groups in terms of demographic data, mean stone burden, duration of surgery, decrease in hematocrit, blood transfusion rates, stone-free rate and complication rates. The median fluoroscopy durations of group 1 and group 2 were 120 and 220 seconds, respectively. Duration of surgery and fluoroscopy were significantly shorter in the single-step dilatation group 

Conclusion: PNL is a safe and effective procedure for pediatric stone diseases. Performing this procedure with a single-step dilatation technique ensures that children are less exposed to radiation.

Keywords

• Single-step dilatation,Nephrolithiasis,Percutaneous nephrolithotomy,Fluoroscopy

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