Erişkin hastalarda mini perkütan nefrolitotomi deneyimlerimiz: Ön çalışma sonuçları

Abstract

Amaç: Erişkin hastalarda böbrek taşlarının tedavisinde mini perkütan nefrolitotomi mPCNL deneyimimizin sunulması amaçlanmıştır. Gereç ve Yöntemler: Haziran 2013 ve Ağustos 2014 tarihleri arasında böbrek taşı tanısı olan 125 87 erkek, 38 kadın hastaya mPCNL uygulandı. Hastaların yaş ortalamaları, cinsiyet, vücut kitle indeksi, aynı taraf böbrek cerrahi hikâyesi, taş boyut, sayısı ve lokalizasyonu kaydedildi. Hastaların radyolojik değerlendirmesi intravenöz pyelografi IVP ve/veya batın tomografisi ile yapıldı. Bulgular: Ortalama taş boyutu 400±300 mm2 saptandı. Hastaların taşları sırası ile %50.4 çoklu kaliks pelvis + en az 1 kaliks taşı ya da bir çok kalikste taşlar , %27,2 alt kaliks, %14.4 renal pelvis, %4 orta kaliks ve %4 üst kaliks lokalizasyonunda yerleşimliydi. Hastaların ortalama ameliyat süresi 113.1±41, ortalama floroskopi süresi ise 6.3±4.1 dakika idi. Ameliyat sonrası ortalama hemoglobin seviyesi düşüşü 1.15±0.86 g/dl olarak saptandı. Hastanede ameliyat sonrası ortalama yatış süresi 70.3±26.9 saat idi. Genel taşsızlık oranı %70.4 saptanırken, bunlardan çoklu kalisiyel sistemde taşı olanlarda taşsızlık %51.8 iken, izole kaliks taşları veya renal pelvis taşlarında taşsızlık %91.2 olarak bulundu. Komplikasyonları modifiye Clavien sınıflaması ile değerlendirdiğimizde, 5 hastada %4 2.derece komplikasyon görülürken, postoperatif dönemde nefrostominin alınmasını takiben nefrostomi traktından idrar akışının devam etmesi nedeni ile DJ katater takılan 26 hastada da %20.8 3. derece komplikasyon olarak saptanmıştır. Sonuç: mPCNL, böbrek taşlarının cerrahi tedavisinde güvenli olması, düşük morbiditeye yol açması ve yüksek oranda taşsızlık oranları ile erişkin hastalarda da tedavide yerini almaktadır.

Keywords

• Erişkin hastalar, mini perkütan nefrolitotomi, tedavi

Experiences of mini percutaneous nephrolithotomy in adult patients: Results of pilot study

Abstract

Objectives: To present our first experiences about treatment of adult kidney stones with mini percutaneous nephrolithotomy mPCNL Material and Methods: Between June 2013 and October 2013, 125 adult patients 87 male and 38 female underwent mPCNL. Mean age, gender, body mass index, stone size and localization, previous surgery history for the same sides were recorded. Radiologic evaluation was done by intravenous pyelography IVP and/or abdominal computed tomography. Results: Mean stone size was 400±300 mm2 . Stone localizations were 50.4% multiple calyxes renal pelvis and at least one calyx or multiple calyx , 27.2% lower calyx, 14.4% renal pelvis, 4% middle calyx and 4% upper calyx. Mean operation time was 113.1±41 minutes and mean fluoroscopy time was 6.3±4.1 minutes. Mean hemoglobin drop was 1.15±0.86 g/dl. Mean hospitalization duration was 70.3±26.9 hours. Stone free rate for all localizations, multiple calyceal stones and single calyx or renal pelvis stones were 70.4%, 51.8% and 91.2% respectively. Complications were evaluated by Modified Clavien classification. 5 patients 4% had grade 2 complication and 26 patients 20.8% had urinary leakage from nephrostomy side and grade 3 complications because of need for double J catheter insertion. Conclusion: mPCNL is a safe treatment for treatment of adult kidney stones with lower morbidity and higher success rates.

Keywords

• Adult patients, mini percutaneous nephrolithotomy, treatment

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