Okul Öncesi Çocuklarda Farklı Kılıf Büyüklüğünde yapılan Mini-Perkütan Nefrolitotomi Sonuçlarının Karşılaştırması

Öz

Amaç: Bu çalımada , bebeklerde ve okul öncesi yaş gruplarındaki çocuklarda mini perkütan nefrolitotomi (Mini-PCNL) uygulanan başarı oranını ve komplikasyonları, kompleks böbrek taşları için iki farklı boyutta traktlarla karşılaştırdık. Materyal ve Metot: Ocak 2002 ile Haziran 2018 tarihleri arasında mini PCNL uygulanan 7 yaşından küçük 260 pediatrik hastanın kayıtları geriye dönük olarak araştırıldı. Karmaşık böbrek taşı hastalığı olan yüz kırk dokuz okul öncesi çocuk ve bebek (66 kız ve 83 erkek) dahil edildi. Çalışmada toplam 158 mini-PCNL gerçekleştirildi ve iki farklı gruba ayrıldı (14Fr grubu, n = 104 [% 69.8]; 20Fr grubu, n = 45 [% 30.2]). Bulgular: Ortalama hasta yaşı 14Fr ve 20Fr gruplarında sırasıyla 3.5 ± 2.0 ve 5.2 ± 2.2 yıl idi (p = 0.158). Hemoglobin düşüşünde (0.73 gr / dL'ye karşı 1.0 gr / dL, p = <0.041), kan transfüzyon hızında (% 3.6'ya karşı 16.7, p = 0.013), floroskopi süresi (4,29 dk. - 5,42 dk., p = <0,001), dakikada ortalama parçalanmış taş boyutu (4,29 mm2 / dk - 5,43 mm2 / dk, p = 0,016), ameliyat süresi (65,2 - 74,1 dk, p = 0.040), kateter çıkarılma süresi (2.58 güne karşı 2.89 gün, p = <0.001) ve hastanede kalış sürelerinde (3.78 güne karşı 4.67 gün, p = 0.010) 20Fr grubuna göre 14Fr grubu daha avantajlıydı. Bununla birlikte, cinsiyette, taşın lateralitesi, yeri, yükü ve opaklığı, hidronefroz varlığı, önceki taş tedavisi sayısı, acsess girişler, kaliksler, taş temizleme oranı, diversiyon tipleri, komplikasyonlar ve taşsızlık oranları açısından istatistiksel bir farklılık gözlenmedi. Sonuçlar: Bu çalışma, 14Fr ile 20Fr kılıfla yapılan mini-PCNL prosedürünün hemoglobin düşüşü, kan transfüzyon hızı, kateter çıkarma süresi ve hastanede kalış süresinin önemli ölçüde azaltılması ile ilgili önemli avantajlı olduğunu göstermiştir. Taşsızlık oranları ve komplikasyonlar her iki grupta benzerdi.

Anahtar Kelimeler

• Nefrolitotomi
• Çocuk
• Endouroloji

Comparison of Different Sheath-sized Mini-Percutaneous Nephrolithotomy in Preschool-aged Children

Abstract

Aim: We compared success rate and complications in infants and preschool-aged children who had undergone mini-percutaneous nephrolithotomy (Mini-PCNL) with two different sizes of tracts for complex renal calculi. Materials and Methods: Two thousand sixty pediatric patients younger than 7 years old who had undergone mini-PCNL between January 2002 and June 2018 were evaluated retrospectively. One hundred forty-nine preschool-aged children and infants (66 girls and 83 boys) with complex kidney stone disease were included. A total of 158 mini-PCNL were performed in the study. These were classified into two groups (the 14Fr group, n=104 [69.8%]; the 20Fr group, n=45 [30.2%]). Results: The mean age of the patients was 3.5±2.0 year-old and 5.2±2.2 year-old in the 14Fr and 20Fr groups, respectively (p=0.158). There was an superiority of 14Fr group over 20Fr group in terms of significant reduction of hemoglobin difference (0.73 gr/dL vs. 1.0 gr/dL, p=<0.041), blood transfusion rate (3.6% vs. 16.7, p=0.013), fluoroscopy time (4.29 min. vs 5.42 min., p=<0.001), mean fragmented stone size per minute (4.29 mm2/min vs 5.43 mm2/min, p=0.016), operative time (65.2 vs 74.1 min, p=0.040 ), catheter removal time (2.58 days vs. 2.89 days, p<0.001) and hospitalization (3.78 days vs. 4.67 days, p=0.010), respectively. However, no significant differences were observed regarding gender, laterality, location, burden, and the opacity of the stone, presence of hydronephrosis, number of previous stone treatments, accesses achieved, calyces accessed, stone clearance rate, diversion types, complications, and stone-free rates between the groups. Conclusions: This study expressed that the mini-PCNL performed by 14Fr was superior over that by 20Fr sheath regarding the significant reduction of hemoglobin drop, blood transfusion rate, catheter removal time, and duration of hospitalization. The stone-free rates and the other parameters were comparable in both groups.

Keywords

• nephrolithotomy
• children
• endourology

Kaynakça

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