Perkütan Nefrolitotomi Yapılan Hastalarda Farklı Anestezi Yöntemlerinin Karşılaştırılması

Year 2020, Volume: 15 Issue: 1, 1 - 6, 26.02.2020

Osman Barut , Sefa Resim

https://doi.org/10.33719/yud.524098

Abstract

Amaç: Günümüzde,
Perkütan nefrolitotomi (PNL) büyük ve kompleks böbrek taşları için ilk tercih
edilen minimal invazif bir tedavi şeklidir. PNL operasyonu spinal ve genel
anestezi altında yapılabilmektedir. Biz bu retrospektif çalışmada spinal ve
genel anestezi altında yapılan  PNL
ameliyatlarının etkinlik ve güvenirliliğini karşılaştırdık.

Gereç ve Yöntem: Çalışmaya kliniğimizde Ekim  2016 ve Ağustos 2018
tarihleri arasında
PNL operasyonu yapılan toplam 82 hasta dahil edildi.
Genel anestezi grubunda (grup 1) 34 ve spinal anestezi grubunda (grup 2) 48
hasta mevcuttu. Bütün hastaların taş ve üriner sistem özellikleri, operasyon
parametreleri ve
postoperatif bulguları kaydedildi. Karşılaştırmalarda
Independent Samples t Test, Mann WhitneyU ve Ki-Kare testleri kullanıldı.
P<0,05 anlamlı kabul edildi.

Bulgular: Sırasıyla; ortalama yaş, cinsiyet ve
taş boyutu açısından iki grup arasında istatistiki olarak anlamlı farklılık
saptanmadı(p=0.20, p=0.83, p=0.24). Ortalama
operasyon süresi grup 1’de anlamlı olarak daha düşüktü (57,91±10,18 dk vs.
53,56±9,33 dk; p:0,04).
Grup 1’de ortalama floroskopi süresi 4,43±1,54 dk iken
grup 2’de 3,56±1,25 dk idi ve anlamlı farklılık izlendi (p=0,008). Grup 1’de taşsızlık oranı %
84,2 iken grup2’de bu oran % 85,5 olarak kaydedildi ve anlamlı farklılık
saptanmadı (p =0,31). Ortalama hastanede kalış süreleri grup 1’de 51,08±11,27 saat, grup 2’de 50,12±11,18 saat idi (p=0,70). Grup 1’de postoperatif başağrısı
olmazken, grup 2’de 4 hastada postoperatifbaş ağrısı oldu ancak bu fark
istatistiksel olarak anlamlı değildi (p=0,13).

Sonuç: PNL operasyonu planlanan
hastalarda spinal anestezi hızlı ve güvenilir bir anestezi yöntemidir. Spinal anestezinin operasyon ve skopi sürelerinin kısa
olması gibi avantajları olması nedeni ile artan sıklıkta kullanılacağı
düşünülmektedir.

Keywords

Perkutan nefrolitotomi , Spinal anestezi , Genel anestezi

Comparison Of Different Anesthesia Methods In Patients With Percutaneous Nephrolithotomy

Abstract

Aim: Nowadays,
percutaneous nephrolithotripsy (PNL) is the first choice of minimally invasive
treatment for large and complex kidney stones. In this
retrospective study, we compared the efficacy and safety of PNL surgeries
performed under spinal and general anesthesia.

Method: A
total of 82 patients who underwent PNL between October 2016 and August 2018
were included in the study. There were 34 patients in the general
anesthesia group (group 1) and 48 patients in the spinal anesthesia group
(group 2). All patients' stone and urinary system features,
operation parameters and postoperative findings were recorded. Independent
Samples t Test, Mann Whitney U and Chi-Square tests were used. P
<0.05 was considered as statistical significance.

Results: There
was no statistically significant difference between the two groups in terms of
mean age, gender and stone sizes respectively (p = 0.20, p = 0.83, p = 0.24).
The
mean operative time was 57.91 ± 10.18 minutes (min) in Group 1 and 53.56 ± 9.33
min in group 2, and there was a statistically significant difference (p =
0.04). The
mean fluoroscopy time in Group 1 was 4.23 ± 1.54 min and 3.56 ± 1.25 min in
group 2 and there was a significant difference (p = 0.008). While
the stone-free rate was 84.2% in group 1, this rate was 85.5% in group 2 and no
significant difference was found (p = 0.31). The mean length of
hospital stay was 51,08 ± 11,27 hours in group 1 and 50,12 ± 11,18 hours in
group 2 (p = 0,70). There was no postoperative headache in
group 1, but 4 patients had postoperative headache in group 2, but this was not
statistically significant (p = 0.13).

Conclusion: Spinal anesthesia is a
fast and reliable method of anesthesia in patients scheduled for PCNL. It is thought that spinal anesthesia will be
used with increasing frequency as it has advantages of short operation and
fluoroscopy times.

Keywords

Percutaneous nephrolithotomy , Spinal anesthesia , General anesthesia

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