Perkütan Nefrolitotomi (PCNL) Esnasında Trakt Dilatasyon Teknikleri Arasındaki Farklılıklar

Abstract

Amaç: Ciltten böbrek taşına kadar olan mesafenin dilatasyonu Perkütan Nefrolitotomi (PCNL) operasyonunun önemli adımlarındandır. Ancak, maliyet ve radyasyon maruziyeti nedeniyle uygun dilatasyon metodu konusunda tartışmalar sürmektedir. Bu amaçla, PCNL’de trakt dilatasyonu esnasında 12F Amplatz dilatatör + balon dilatatör kullanımının dilatasyon ve skopi süresi üzerine etkisini değerlendirmek için kontrollü klinik çalışma planlandı.

Gereç ve Yöntemler: Böbrek taşı nedeniyle PCNL endikasyonu olan 60 hasta çalışmaya dahil edildi ve 3 gruba ayrıldılar. Grup 1’de sadece 12F Amplatz ile dilatasyon sonrası balon dilatasyonu yapılırken, Grup 2’de öğretilerde tarif edildiği gibi sırasıyla 8/10 dilatatör/sheat set, dual-lümen üreteral katater ve Zebra^TM açılı uçlu kılavuz tel sonrası balon dilatasyon uygulandı. Grup 3’de ise balon dilatatör uygulanmadan 10-30F arası Amplatz dilatatörler ile trakt dilatasyonu sağlandı. Taşa erişim süresi, dilatasyon süresi, amelitay süresi, skopi süresi, maliyet, nefrostomi tüpünün çıkarılma süresi ve hastanede kalış süresi parametreleri kaydedildi.

Bulgular: Dilatasyon süresi, operasyon süresi  ve skopi süresi Grup 1’de diğer iki grup ile karşılaştırıldığında anlamlı derecede daha kısaydı (p<0.05). Maliyet Grup 2’de diğer gruplar ile karşılaştırıldığında daha fazlaydı.

Sonuç: Kısa dilatasyon süresi, kısa operasyon süresi, düşük skopi zamanı ve düşük maliyet nedeniyle 12F Amplatz dilatör kullanılarak balon dilatasyonun yapılması avantajlı görünmektedir.

Keywords

• Böbrek taşları,Perkütan nefrolitotomi,12F amplatz dilatator,Balon dilatasyonu

Differences between types of tract dilatation techniques during percutaneous nephrolithotomy (PCNL).

Abstract

Aim: Dilation of the distance from the skin to the kidney stone is one of the important steps of percutaneous nephrolithotomy (PCNL).However, due to cost and exposure to radiation, there is a debate about the proper dilatation method. For this purpose, a controlled clinical trial was planned to evaluate the effectiveness of the use of 12 F Amplatz dilator + balloon dilator in terms of shorter duration of tract dilation and scopy time during PCNL.

Material and Methods: 60 patients with kidney stones and performed PCNL were included in the study and divided into 3 groups. While balloon dilation was maintained after using 12F Amplatz dilator -only- in Group 1, balloon dilation was performed after using 8/10 dilator/sheat set, dual-lumen ureteral catheter and Zebra^TM angled type guidewire as described in the teachings in Group 2. Dilation in patients in Group 3 was performed with just Amplatz dilators ranging from 10F to 30F without using balloon dilation. The access time, dilation time, operation time, scopy time, cost, nephrostomy tube removal time, hospital stay period parameters were recorded.

Results: Dilation, operation and scopy times were significantly lower in Group 1 compared to the two other groups (p<0.05).  The costs were higher in Group 2.                        

Conclusion: Due to the shorter dilation, scopy and operation time and cost benefits, using 12F Amplatz dilator before and then balloon dilator seems advantageous. 

Keywords

• kidney stones,Percutaneous nephrolithotomy,12F amplatz dilator,balloon dilatation

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