Endoskopik üreterolitotripside kullanılan farklı güçteki lazerlerin serolojik ve radyolojik biyobelirteçlerle değerlendirilmesi
Yükleniyor...
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ VE AMAÇ: Üriner sistem taş hastalığı ülkemizde sık görülen bir hastalık olup bu
olguların yaklaşık %20 sini üreter taşı olan olgular oluşturmaktadır. Üreter taşlarının
endoskopik tedavisinde kullanılan yöntemler gelişen litotriptör ve lazer teknolojisi ile birlikte
hızlı bir gelişim ve değişim göstermektedir. Gelişen lazer teknolojisi ile birlikte daha güçlü
lazerlerin kullanımı yaygınlaşmıştır. Yeni teknoloji, etkin fragmantasyon ve düşük operasyon
süreleri açısından umut vaad etmektedir. Bu çalışmanın amacı üreter taşı fragmantasyonunda
kullanılan standart holmium lazer tedavisi ile yüksek güçlü lazer tedavisinin etkinliği ve
güvenilirliğinin karşılaştırılmasıdır.
MATERYAL-METOD: Çalışmamıza Üroloji Kliniğine Ekim 2023-Ocak 2024 tarihleri
arasında üreter taşı nedeni ile başvuran ve lazer endoskopik ureterolitotoripsi uygulanan
toplam 122 hasta dahil edilmiştir. Bu hastalar yüksek güçlü lazer tedavisi uygulanan 61 hasta
(grup-1) ve düşük güçlü lazer tedavisi uygulanan 61 hasta (grup-2) olarak iki gruba
ayrılmıştır. Hastaların demografik özellikleri, taş boyutları ve özellikleri, operasyon öncesi,
operasyona ait ve operasyon sonrası verileri kaydedilmiş ve veriler SPSS programı yardımı ile
değerlendirilmiştir.
BULGULAR: Çalışmaya dahil edilen hastaların ortalama yaşı 51,12 (23-75) iken grup-1’de
52,91± 14,62 grup-2’de 49,32±14,39 saptandı. (p:0,16).Tüm hastaların 77 si erkek (%63,1),45
i kadındı.(%36,9) Hastaların genel ortalama BMI değeri 26,57±3,62 dir. Genel hasta
populasyonunda ortalama taş boyutu 9,57±3,33 mm (4-19) iken grup-1 ortalama taş boyutu
9,19±3,27mm, grup-2 de 9,95±3,38 mm saptanmış olup her iki grup taş boyutu benzerdi.
(p:0,16) Genel hasta populasyonunda daş dansite ortalaması 785,91±174,83 HU (403-1240)
saptanırken grup-1 HU değeri 805,52±141,78 HU, grup-2 HU değeri 766,29±201,8 HU
saptanmıştır.(p:0,06) İki grup için operasyon öncesi ve operasyon sonrası değerlendirilen
laboratuar bulguları benzer olduğu görüldü. Fragmantasyon süreleri grup-1 de 9,44 ±3,68 dk
iken grup-2 de 16,63 ±8,62 dk saptandı.(p<0,05).Operasyon süreleri grup-1 de
28,09±8,04 dk grup-2 de 33,39±13,82 dk saptandı. (p<0,05) Operasyon esnasından kullanılan
skopi süreleri ve hastaların hastanede yatış süreleri açısından iki grup arasında anlamlı bir fark
saptanmadı. Taşsızlık oranları da grup-1 ve grup-2 arasında benzer saptandı.(p:0,72) Grup-1
de 4 hastada clavien grade-1 komplikasyon görülürken grup 2 de 3 hastada clavien grade-1
ve 1 hastada clavien grade 3A komplikasyon izlendi. Hastaların operasyon sonrası 3.ay
hidronefroz takibinde grup-1 de 1 hastada grade-2 ve 1 hastada grade-1 hidronefroz izlendi.
Grup-2 de 2 hastada grade-1 hidronefroz ve 1 hastada grade-2 hidronefroz izlendi. Gruplar
arasında komplikasyon ve post-operatif 3.ay hidronefroz takibi açısından anlamlı bir fark
izlenmedi.
SONUÇ: Çalışmamızda üreter taşlarının endoskopik tedavisinde standart tedaviye seçenek
olarak kullanılabilecek olan yüksek güçlü lazer tedavisinin taş fragmantasyonunda daha hızlı
ve etkin bir fragmantasyon sağladığı ve bu sayede operasyon sürelerini düşürebileceği
görülmektedir. Serolojik bulgular ve komplikasyon oranlarında standart tedaviye göre
farklılık olmaması kullanımının güvenli olduğuna dair bulgular veririken 3. ay kontrollerde
herhangi bir patoloji görülmemesi uzun dönem sonuçlarının da güvenilirliğine işaret
etmektedir.
İNTRODUCTİON: Urinary tract stone disease is a common disease in our country and approximately 20% of these cases are ureteral calculi. The methods used in the endoscopic treatment of ureteral calculi are rapidly developing and changing with the advances in lithotripter and laser technology. With the development of laser technology, the use of more powerful lasers has become widespread. The new technology is promising in terms of effective fragmentation and low operation times. The aim of this study was to compare the efficacy and safety of standard holmium laser therapy and high power laser therapy for ureteral stone fragmentation. MATERIAL-METHOD: A total of 122 patients who were admitted to the Urology Clinic between October 2023 and January 2024 for ureteral calculi and underwent laser endoscopic ureterolithotoripsy were included in our study. These patients were divided into two groups as 61 patients who underwent high power laser treatment (group-1) and 61 patients who underwent low power laser treatment (group-2). Demographic characteristics, stone size and characteristics, preoperative, operative and postoperative data of the patients were recorded and the data were evaluated with the help of SPSS program. RESULTS: The mean age of the patients included in the study was 51.12 years (23-75), 52.91±14.62 in group-1 and 49.32±14.39 in group-2 (p:0.16).77 of all patients were male (63.1%) and 45 were female (36.9%). The overall mean BMI of the patients was 26.57±3.62. While the mean stone size was 9.57±3.33 mm (4-19) in the general patient population, the mean stone size was 9.19±3.27 mm in group-1 and 9.95±3.38 mm in group-2 and both groups had similar stone sizes. (p:0.16) In the general patient population, the mean stone density was 785.91±174.83 HU (403-1240), group-1 HU was 805.52±141.78 HU and group-2 HU was 766.29±201.8 HU (p:0.06). Preoperative and postoperative laboratory findings for the two groups were similar. Fragmentation times were 9.44±3.68 min in group-1 and 16.63±8.62 min in group-2.(p<0.05).Operation times were 28.09±8.04 min in group-1 and 33.39±13.82 min in group-2. .(p<0,05) There was no significant difference between the two groups in terms of the duration of intraoperative scopy and hospitalization times of the patients. Stone-free rates were similar between group-1 and group-2.(p:0,72).4 patients in group-1 had clavien grade-1 complications, while 3 patients in group-2 had clavien grade-1 and 1 patient had clavien grade 3A complications. In the 3rd month postoperative hydronephrosis follow-up of the patients, grade-2 hydronephrosis was observed in 1 patient in group-1 and grade-1 hydronephrosis was observed in 1 patient. In group-2, 2 patients had grade-1 hydronephrosis and 1 patient had grade-2 hydronephrosis. There was no significant difference between the groups in terms of complications and post-operative 3rd month hydronephrosis follow-up. CONCLUSİON: In our study, high-power laser therapy, which can be used as an alternative to standard treatment in the endoscopic treatment of ureteral stones, provides a faster and more effective fragmentation of the stone fragmentation and thus may reduce the operation times. The fact that there is no difference in serologic findings and complication rates compared to standard treatment indicates that it is safe to use, and the fact that no pathology was observed in the 3rd month controls indicates that the long-term results are also reliable.
İNTRODUCTİON: Urinary tract stone disease is a common disease in our country and approximately 20% of these cases are ureteral calculi. The methods used in the endoscopic treatment of ureteral calculi are rapidly developing and changing with the advances in lithotripter and laser technology. With the development of laser technology, the use of more powerful lasers has become widespread. The new technology is promising in terms of effective fragmentation and low operation times. The aim of this study was to compare the efficacy and safety of standard holmium laser therapy and high power laser therapy for ureteral stone fragmentation. MATERIAL-METHOD: A total of 122 patients who were admitted to the Urology Clinic between October 2023 and January 2024 for ureteral calculi and underwent laser endoscopic ureterolithotoripsy were included in our study. These patients were divided into two groups as 61 patients who underwent high power laser treatment (group-1) and 61 patients who underwent low power laser treatment (group-2). Demographic characteristics, stone size and characteristics, preoperative, operative and postoperative data of the patients were recorded and the data were evaluated with the help of SPSS program. RESULTS: The mean age of the patients included in the study was 51.12 years (23-75), 52.91±14.62 in group-1 and 49.32±14.39 in group-2 (p:0.16).77 of all patients were male (63.1%) and 45 were female (36.9%). The overall mean BMI of the patients was 26.57±3.62. While the mean stone size was 9.57±3.33 mm (4-19) in the general patient population, the mean stone size was 9.19±3.27 mm in group-1 and 9.95±3.38 mm in group-2 and both groups had similar stone sizes. (p:0.16) In the general patient population, the mean stone density was 785.91±174.83 HU (403-1240), group-1 HU was 805.52±141.78 HU and group-2 HU was 766.29±201.8 HU (p:0.06). Preoperative and postoperative laboratory findings for the two groups were similar. Fragmentation times were 9.44±3.68 min in group-1 and 16.63±8.62 min in group-2.(p<0.05).Operation times were 28.09±8.04 min in group-1 and 33.39±13.82 min in group-2. .(p<0,05) There was no significant difference between the two groups in terms of the duration of intraoperative scopy and hospitalization times of the patients. Stone-free rates were similar between group-1 and group-2.(p:0,72).4 patients in group-1 had clavien grade-1 complications, while 3 patients in group-2 had clavien grade-1 and 1 patient had clavien grade 3A complications. In the 3rd month postoperative hydronephrosis follow-up of the patients, grade-2 hydronephrosis was observed in 1 patient in group-1 and grade-1 hydronephrosis was observed in 1 patient. In group-2, 2 patients had grade-1 hydronephrosis and 1 patient had grade-2 hydronephrosis. There was no significant difference between the groups in terms of complications and post-operative 3rd month hydronephrosis follow-up. CONCLUSİON: In our study, high-power laser therapy, which can be used as an alternative to standard treatment in the endoscopic treatment of ureteral stones, provides a faster and more effective fragmentation of the stone fragmentation and thus may reduce the operation times. The fact that there is no difference in serologic findings and complication rates compared to standard treatment indicates that it is safe to use, and the fact that no pathology was observed in the 3rd month controls indicates that the long-term results are also reliable.
Açıklama
Anahtar Kelimeler
Endoskopi, Endoscopy, Üreterolitotripsi, Ureterolithotripsy, Üriner sistem, Urinary system, Taş hastalığı, Stone disease
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Erol, E. (2024). Endoskopik üreterolitotripside kullanılan farklı güçteki lazerlerin serolojik ve radyolojik biyobelirteçlerle değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Üroloji Anabilim Dalı, Konya.
