Üreteropelvik Darlıkta Klinik, Radyolojik ve Sintigrafik Verilerin Laparoskopik Piyeloplasti Sonrası Erken ve Geç Dönem Seyrinin Değerlendirilmesi

Yıl 2023, Cilt: 45 Sayı: 2, 222 - 229, 15.03.2023

Çiğdem Arslan Alıcı , Mehmet Surhan Arda , Umut Alıcı , Huseyin Ilhan, Turkey , Baran Tokar

https://doi.org/10.20515/otd.1187227

Öz

Üreteropelvik bileşke darlığı (ÜPBD), idrarın renal pelvisden üretere yetersiz transportununa neden olur. Laparoskopik piyeloplasti (LP), üreteropelvik bileşke darlığı (ÜPBD) olan hastalarda teknolojik gelişmelerle birlikte artan bir sıklıkta cerrahi yöntem olarak tercih edilmektedir. Bu çalışmada ÜPBD nedeniyle LP yapılan olguların tedavi öncesi klinik, radyolojik ve sintigrafik bulgularının, tedavi sonrası erken ve geç dönemdeki seyrinin karşılaştırarak sonuçların değerlendirilmesi amaçlanmıştır. Bu çalışmaya, Ocak 2010-Mayıs 2016 tarihleri arasında Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Çocuk Cerrahisi Anabilim Dalı’nda ÜPBD nedeniyle LP uygulanan 68 olgu dahil edildi. Retrospektif olarak yapılan bu çalışmada olguların demografik özellikleri, klinik bulguları, intraoperatif özellikleri ve preoperatif ve postoperatif klinik, radyolojik ve sintigrafik incelemelerinin takipleriyle ilgili veriler değerlendirildi. ÜPBD nedeniyle 68 hastaya(51 erkek, 17 kız) LP yapıldı. Çalışmaya dahil edilen hastaların, 24’ü antenatal hidronefroz, 46’sı karın ağrısı, hematüri ve idrar yolu enfeksiyonu (İYE) bulguları sonrasında yapılan tetkikler sonucunda ÜPBD tanısı aldı. Hastalar ameliyat öncesi USG ve DTPA-MAG3 görüntülemeleriyle takip edildi. Cerrahi esnasında hastaların 13’ünde (%19.1) aberan damar basısı, 4’ünde(%5.8) malrotasyon ve birinde (%1.4) polip saptandı. Hastaların 13’ünde (%19.1) transmezokolik LP, 55’inde(%80.8) retrokolik LP uygulandı; 33 hastada laparoskopi yardımlı ekstrakorporeal piyeloplasti yapıldı. Hastalar postoperatif dönemde 1,3,6. ay ve 1. yılda USG ve 6. Ayda DTPA-MAG3 görüntülemeleriyle takip edildi. Postoperatif USG takiplerinde hidronefrozun gerilediği (p<0.001), parankim kalınlığının arttığı (p<0.001), kalisiyel dilatasyonun azaldığı (p<0.001) gözlendi. Sintigrafide, postoperatif dönemde böbrek fonksiyonlarının istatiksel olarak anlamlı olmamakla birlikte (p>0.05) arttığı ve aktivite yarılanma sürelerinin azaldığı (p>0.05) gözlendi. LP deneyimli kliniklerde uygun endikasyonlar ile yapıldığında başarılı sonuçları olan bir cerrahi tedavi yöntemidir.

Anahtar Kelimeler

Laparoskopik piyeloplasti, Hidronefroz, Ürteropelvik bileşke darlığı, Pediatrik, Diferansiyel böbrek fonksiyonu

Destekleyen Kurum

yok

Proje Numarası

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Evaluation of Early and Late Clinical, Radiological and Scintigraphic Datas After Laparoscopic Pyeloplasty in Ureteropelvic Junction Obstruction

Öz

Ureteropelvic junction obstruction(UPJO) causes inadequate transport of urine from the renal pelvis to the ureter. Laparoscopic pyeloplasty(LP) is increasingly preferred in patients with UPJO. We aimed to compare the clinical, radiological and scintigraphic findings before the treatment and the early and late progress of the patients underwent LP for UPJO. Sixty-eight cases underwent LP for UPJO(January 2010-May 2016) were included. Demographic characteristics, clinical findings, intraoperative characteristics, data on preoperative and postoperative clinical, radiological and scintigraphic follow-ups of the cases were evaluated retrospectively. LP was performed in 68 patients(51 males, 17 females) for UPJO. Twenty-four patients with antenatal hydronephrosis, 46 patients with abdominal pain, hematuria and urinary tract infection(UTI) findings were diagnosed with UPJO. Patients were preoperatively followed up by USG and DTPA-MAG3 imaging. During surgery, aberrant vessel in 13(19.1%) patients, malrotation in 4(5.8%) and polyp in one(1.4%) patient were detected. Thirteen patients(19.1%) underwent surgery with the transmesoolic approach, 55 patients(80.8%) underwent retrocolic surgery, 33 patients underwent laparoscopy-assisted extracorporeal pyeloplasty. In postoperative period, patients were followed up at 1st, 3rd, 6th months and in the first year with USG and at 6th months with DTPA-MAG3 imaging. Postoperative USG follow up showed a decrease in hydronephrosis(p<0.001), an increase in parenchymal thickness(p<0.001), and a decrease in caliceal dilatation(p<0.001). In scintigraphic data, renal function was increased but it is not statistically significant(p>0.05) and activated half-time was decreased(p<0.05) in postoperative period. LP is a surgical treatment method with successful results when performed with appropriate indications in experienced clinics.

Anahtar Kelimeler

Laparoscopic pyeloplasty, Hydronephrosis, Ureteropelvic junction obstruction, Pediatric, Differential kidney function

Proje Numarası

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Kaynakça

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