2 cm ve üzeri böbrek taşlarında perkütan nefrolitotomi başarısını etkileyen faktörlerin değerlendirmesi

Year 2020, , 230 - 234, 01.03.2020

Osman Barut , Mehmet Kutlu Demirkol

https://doi.org/10.28982/josam.700250

Abstract

Amaç: Perkütan nefrolitotomi (PNL), büyük ve karmaşık böbrek taşları için tercih edilen minimal invaziv tedavi yöntemi olmasına rağmen, komplikasyonlar gelişebilir ve operasyon başarısızlıkla sonuçlanabilir. Bu çalışmada PNL’de başarıyı etkileyen faktörleri ve cerrahi tecrübenin PNL’ye etkisini değerlendirmeyi amaçladık.
Yöntemler: Bu retrospektif kohort çalışmasında, Eylül 2017 ve Ağustos 2019 tarihleri arasında PNL operasyonu yapılan toplam 106 hastanın kayıtları incelendi. Bütün hastaların taş ve üriner sistem özellikleri, operasyon parametreleri ve postoperatif bulguları kaydedildi. Cerrahi tecrübe sırasıyla ilk 53 ve son 53 vaka olmak üzere iki gruba ayrıldı. Taşlar böbrekteki yerleşimine göre basit taşlar ve kompleks taşlar olarak sınıflandırıldı. Hastalar operasyon sonrası 1. gün çekilen direk üriner sistem grafisi (DÜSG) ve 3. ayda çekilen kontrastsız bilgisayarlı tomografi (BT) ile değerlendirildi.
Bulgular: PNL uygulanan 106 hastanın 64’ü (%60,3) erkek, 42’si kadın (%39,7), ortalama yaş 52,65 (9,36) yıl idi. Hastaların taş boyutları ortalama 4,25 (1,37) cm idi ve 48’i basit taşlara, 58’i kompleks taşlara sahipti. Ortalama operasyon süresi 58,70 (9,41) dk., ortalama yatış süresi 52,11 (8,62) saat idi. 106 böbrek taşı vakasının 90’ında (%84,9) postoperatif birinci günde çekilen DÜSG’de başarı elde edildi. Olguların 8´ine uygulanan ek tedavi sonrası postoperatif 3. ayda bu oran %92,4’e yükseldi. Operasyon sonrası 3. ay basit böbrek taşlarındaki taşsızlık oranı %91,7 iken, kompleks böbrek taşlarında bu oran %79,3 olarak bulundu. Cerrahi tecrübenin etkisi değerlendirildiğinde ilk 53 vakada %22,7, son 53 vakada %7,6 başarısızlık saptandı (P=0,016).
Sonuç: PNL, 2 cm ve üzeri basit ve kompleks böbrek taşlarında tercih edilebilecek minimal invaziv bir tedavi yöntemidir. Taşın boyutu, taşın lokalizasyonu, perkütan girişim sayısı ve cerrahi tecrübe başarı oranlarını etkileyen önemli faktörlerdir.

Keywords

Perkütan nefrolitotomi, Böbrek taşları, Cerrahi tecrübe

Evaluation of factors affecting the success of percutaneous nephrolithotomy in kidney stones sized 2 cm and above

Abstract

Aim: Although percutaneous nephrolithotomy (PNL) is the preferred minimally invasive treatment method for large and complex kidney stones, complications may develop, and the operation may fail. In this study, we aimed to evaluate the factors affecting the success of PNL as well as the significance of surgical experience.
Methods: In this retrospective cohort study, the reports of 106 patients who underwent PNL between September 2017 and August 2019 were analyzed. The features of the stones and urinary system, operation parameters and postoperative findings of all patients were noted. The surgical experience was divided into two groups as the first 53 and the last 53 cases. The stones were classified as simple stones and complex stones by their location in the kidney. The patients were evaluated with kidney ureter bladder (KUB) x-ray on the first day after the operation and by non-contrasted computed tomography (CT) in the 3rd postoperative month.
Results: Among 106 patients who underwent PNL, 64 (60.3%) were male, 42 were female (39.7%), and the mean age was 52.65 (9.36) years. The mean size of the stones in the patients was 4.25 (1.37) cm, and 48 of them had simple stones and 58 had complex stones. The mean operation time was 58.70 (9.41) minutes, and the mean duration of hospitalization was 52.11 (8.62) hours. KUB was successful in 90 (84.9%) of 106 kidney stone cases in the first postoperative day. Following additional treatment administration in 8 cases, this rate increased to 92.4% in the 3rd postoperative month, in which the rate of stone-free cases was 91.7% in simple kidney stones, and 79.3% in complex kidney stones. Assessment of surgical experience revealed that failure rate was 22.7% in the first 53 cases and 7.6% in the last 53 cases (P=0.016).
Conclusion: PNL is a minimally invasive treatment method that may be preferred in simple and complex kidney stones of 2 cm and above. The size of the stone, the localization of the stone, the number of percutaneous interventions and surgical experience are crucial factors affecting success rates.

Keywords

Percutaneous nephrolithotomy, Kidney stones, Surgical experience

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