Perkütan nefrolitotomi operasyonlarında kullanılan balon ve amplatz dilatasyon tekniklerinin karşılaştırılması

Abstract

Amaç: Çalışmamızda kliniğimizde perkutan nefrolitotomi PNL operasyonlarında, amplatz dilatatör ve balon dilatatör kullandığımız vakaları karşılaştırdık. Gereç ve Yöntemler: Temmuz 2008–Eylül 2011 tarihleri arasında, Ankara Eğitim ve Araştırma Hastanesi 2. Üroloji kliniğinde uygulanan PNL operasyonları iki gruba ayrılarak, operasyon sırasında kullanılan dilatasyon teknikleri belirlendi. Çalışmaya toplam 273 hasta 173 erkek ve100 kadın 320 renal ünite dahil edildi. 320 renal ünitenin 204’ünde %63.75 amplatz, 116’sında %36.25 balon dilatasyon tekniği kullanıldı. Hastalar postoperatif 1.gün ve 3.ay taşsızlık oranı, hemoglobin düşüşü, hastanede yatış süresi, cerrahi süreleri, skopi süresi açısından retrospektif olarak karşılaştırıldı. Bulgular: Balon ve amplatz kullanılan hastalar karşılaştırıldığında ortalama hemoglobin düşüşü Amplatz: 1,31Ü - Balon: 1,03Ü , cerrahi süreleri Amplatz: 64,41dk.- Balon:57,26 dk. , skopi süresi Amplatz: 162,45 sn. - Balon: 129,27 sn. arasında istatistiksel olarak anlamlı fark tespit edildi p0.05 . Sonuç: Balon dilatatörün ekonomik açıdan pahallı oluşu, kullanımının tecrübe gerektirmesi ve tek kullanımlık olması dezavantajlarıdır. Amplatz dilatatörün birden çok kullanılabilir olması, balon dilatatöre göre daha ucuz olması gibi avantajları mevcuttur ve tecrübeli hekimler tarafından uygulandığında cerrahi süresi, kanama miktarı ve skopi süresi daha düşük derecelerde tutulabilir

Keywords

• balon dilatasyon,amplatz dilatasyon,perkütan nefrolitotomi

Comparison of amplatz and balloon dilatation techniques in percutaneous nephrolithotomy cases

Abstract

Objectives: In our study, we compared the percutaneous nephrolithotomy cases with amplatz dilatation to the cases with balloon dilatation. Materials and Methods: Our study was carried out at Ankara Training and Research Hospital, 2. Urology deparment, from July 2008 to September 2011. Percutaneous nephrolithotomy cases were divided in to two groups and different dilatation techniques were used for each group. 273 patients 173 male and 100 female and 320 renal unites were included in to the study. Amplatz dilatation technique was used in 204 of 320 renal unites %63.75 and balloon dilatation technique was used in 116 cases %36.25 . Stone free rates for the first postoperative day and the third month, hemoglobine decrease, hospitalization time and scopy time for all cases were compared in a retrospective design. Results: In the comparison of the cases with amplatz and balloon dilatation, the mean hemoglobine decreases Amplatz: 1,31 u.- Balloon: 1,03 u. , mean operation time Amplatz: 64,41 min. – Balloon: 57,26 min. and mean scopy time Amplatz: 162,45 sec. – Balloon: 129,27 sec. were found as statistically significant p0.05 . Conclusion: The balloon dilatation technique is expensive, single use and requires experience. These are the disadvantages of this technique. Amplatz dilatation has advantages like it is re-usable and cheaper than balloon. Also, amplatz technique reduces operation time, blood loss and scopy time in experienced hand.

Keywords

• balloon dilatation,amplatz dilatation,perkutaneous nephrolitotomi

References

1. Yaman LS, Göğüs O, Müftüoğlu YZ, Küpeli S, Anafarta K, Şafak SM, Bedük Y, Arıkan N. Üroloji l. Baskı Ankara 1990.p.61-86.
2. Tanagho EA, McAninch JW. Eds.G. Smith Genel Üroloji. 1999.p.276-30.
3. Resnick MI, Pak CYC. Eds. Urolithiasis A Medical and Surgical Reference. Philadeiphia.W.B.Saunders Company. 1990.p. 201-252.
4. Fernstrom I, Johanson B. Percutaneous pyelolithotomy. Scand J Urol Nephrol 1976;10:257.
5. Matlaga BR, Assimos DG. Changing indications of open stone surgery. J Urol 2002;59:490– 494.
6. Lee WJ, Smith AD, Cubelli V, Badlani GH, Lewin B, Vernace F, Cantos E. Complications of percutaneous nephrolithotomy. Air Am J Roentgenol 1987;148:177.
7. Kukreja R, Desai M, Patel S, Bapat S, Desai M. Factors affecting blood loss during percutaneous nephrolitho- tomy. Prospective study. J Endourol 2004;18:715-722.
8. Kessaris DN, Bellman GC, Pardalidis NP, Smith AG. Ma- nagement of hemorrhage after percutaneous renal surgery. J Urol 1995;153:604-608.

9. Stoller ML, Wolf JS Jr., St Lezin MA. Estimated blood loss and transfusion rates associated with percutaneous nephrolithotomy. J Urol 1994;152:1977.
10. Davidoff R, Bellman GC. Influence in technique of per- cutaneous trackt creation on incidence of renal hemorr- hage. J Urol 1997;157:1229.
11. Lahme S, Bichier KH, Strohmaier WL, Gotz T. Minimally invasive PNL in patients with renal pelvic and caliceal sto- nes. J Urol 2001;40:619.
12. Lopes T, Sangam K, Alken P, Barroilhet BS, Saussine C, Shi L, et al. The Clinical Research Office of the Endourologi- cal Society. Percutaneous Nephrolithotomy Global Study: Tract dilation comparisons in 5537 patients. J Endourol 2011;25:755-62.
13. Marberger M, Stacki W, Hruby W, Kroiss A: Late se- quelae of ultrasonic lithotripsy of renal calculi. J Urol 1985.133:170-173.
14. Ünsal A, Koca G, Reşorlu B, Bayindir M, and Korkmaz M. Effect of Percutaneous Nephrolithotomy and Tract Dilata- tion Methods on Renal Function: Assessment by Quanti- tative Single-Photon Emission Computed Tomography of Technetium-99m–Dimercaptosuccinic Acid Uptake by the Kidneys J Endourol 2010;24:9-12.
15. Davidoff R, Bellman GC. Influence of technique of percu- taneous tract creation on incidence of renal hemorrhage. J Urol 1997;157:1229–1231.
16. Clayman RV, Elbers J, Miller RP.Percutaneous neph- rostomy: Assesment of renal damage associated with semi-rigid (24F) and balloon (36F) dilatation. J Urol, 1987;138:203.
17. Gönen M, İstanbulluoğlu O.M, Çiçek T, Öztürk B, Özkar- deş H. J Endourol 2008;22:5-8.