Perkütan nefrolitotomide tekli ve çoklu girişlerin glomerüler filtrasyon hizi üzerine olan etkilerinin karşılaştırılması

Year 2016, , 195 - 199, 01.12.2016

Deniz Bolat , Mehmet Erhan Aydın Serkan Yarımoğlu Tansu Değirmenci İbrahim Halil Bozkurt Özgü Aydoğdu Tarık Yonguç

https://doi.org/10.21601/ortadogutipdergisi.271539

Abstract

Amaç:
Bu çalışmada böbrek taşı nedeniyle perkütan nefrolitotomi (PNL) yapılan
hastalarda giriş sayısı ile glomeruler filtrasyon hızındaki (GFR) değişimler
arasındaki ilişki değerlendirilmiştir.

Gereç ve Yöntem:
Ocak 2012-Eylül 2015
arasında PNL uygulanan 564 hasta çalışmaya dahil edildi. Hastalar tıbbi
hikayeleri, laboratuvar ve görüntüleme yöntemleriyle değerlendirildiler. Tüm
hastalara operasyon sırasında standard PNL tekniği uygulandı. Yapılan giriş
sayısına gore hastalar iki gruba ayrıldılar: tekli giriş yapılanlar grup-1’e,
çoklu giriş yapılanlar grup 2’ye dahil edildiler. GFR’yi belirlemek için
Cockcroft-Gault formulü ile tahmini kreatinin klerensi hesaplandı. GFR
ölçümleri preoperatif olarak ve postoperatif 1. ve 3. aylarda yapıldı.

Bulgular: Ortalama yaşlar grup-1 ve grup-2 için, sırasıyla, 48.5±12.7 ve 47.6±12.9 yıl idi. Ortalama taş boyutu grup-1’de
501.88±517.61 mm², grup-2’de 622.36±607.16 mm² (p=0.151)
idi. Ortalama preoperatif GFR değerleri 100.36±32.08 ml/dk ile 101.49±36.65 ml/dk
idi ve aradaki fark anlamlı değildi (p=0.803). Postoperatif 1. ve 3. aylardaki
ortalam GFR’ler grup-1 ve 2 için sırasıyla, 91.13±31.10 ml/dk karşılık
91.63±33.74 ml/dk ve 97.32±30.89 ml/dk karşılık 96.44±30.09  ml/dk idi. Bununla birlikte aradaki farklar
anlamlı değildi (p=0.836 ve p=0.483). Postoperatif 3. aydaki GFR değişimi
grup-1’ de grup 2’ye kıyasla daha düşüktü (-3.04±20.37 ml/dk karşılık
-5.05±22.95 ml/dk) ve aradaki fark anlamlı değildi (p=0.483).

Sonuç: PNL operayonu sonrası GFR düşmektedir. Tekli ve çoklu
girişlerin böbrek fonksiyonları üzerine olan etkisi benzerdir. Hastaların
taşsızlık oranlarını artırmak için, böbrek fonksiyonlarında herhangi bir
bozulma olmaksızın, çoklu girişler yapılabilir.

Keywords

Perkütan nefrolitotomi, böbrek fonksiyonları, glomerüler filtrasyon hızı, kreatinin klerensi

Comparing the effects of single and multiple accesses on the glomerular filtration rates in percutaneous nephrolithotomy

Abstract

Aim:
In this study, we assessed
the relationship between number of access and changes on glomerular filtration
rate (GFR) in patients who underwent percutaneous nephrolithotomy (PNL) for
kidney stones.

Material
and Method: Between
January 2012 and September 2015, 564 patients who underwent PCNL were included
in this study. Patients were evaluated by medical history, laboratory and
imaging methods. Standard PCNL technique was applied to all the patients during
the operation. According to the access number, patients were divided into two
groups: Single access was performed in Group-1 and multiple accesses were
performed in Group-2. To determine the GFR, estimated creatinine clearance was
calculated by the Cockcroft-Gault Formula. GFR measurements were performed
preoperatively and on the post-operative 1st and 3rd months.

Results:
The
mean ages in group-1 and group-2 were 48.5±12.7 and 47.6±12.9 years,
respectively (p=0.613). The mean stone size was 501.88±517.61 mm² in
group-1 and 622.36±607.16 mm² in group-2 (p=0.151). Mean
preoperative GFR levels were 100.36±32.08 ml/min and 101.49±36.65 ml/min, and
the difference was not statistically significant (p=0.803). On the
postoperative 1st and the 3rd months, mean GFRs were 91.13±31.10 ml/min vs
91.63±33.74 ml/min and 97.32±30.89 ml/min vs 96.44±30.09 ml/min in group-1 and group-2,
respectively. However, the differences were not statistically significant
(p=0.836 and p=0.483). Although the GFR changes on the postoperative 3rd month
were lower in group-1 when compared to group-2 (-3.04±20.37 ml/min
vs-5.05±22.95 ml/min), the difference was not statistically significant
(p=0.483).

Conclusion: After
PNL surgery, GFR decreases. Effects of single and multiple accesses on the
kidney function are similar. In order to increase the stone-free rates of the
patients, multiple accesses can be performed without any impairment on renal
functions.

Keywords

Percutaneous nephrolithotomy, renal functions, glomerular filtration rate, creatinine clearance

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