1.5 cm'den küçük böbrek alt kaliks taşlarının tedavisinde mikro perkütan nefrolitotomi ve retrograd intrarenal cerrahi yöntemlerinin karşılaştırılması
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2016
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info:eu-repo/semantics/openAccess
Özet
Bu çalışmada alt kaliks yerleşimli, 1,5 cm'den küçük tek böbrek taşı olan hastalardaki minimal invaziv tedavi seçeneklerinden mikro-perkütan nefrolitotomi (mikro-PNL) ve retrograt intrarenal cerrahi (RIRC) etkinlik ve komplikasyonlarının karşılaştırılması amaçlandı. Yöntem ve Gereçler: Mart 2013 - Aralık 2015 tarihleri arasında alt kaliks yerleşimli, 1,5 cm'den küçük tek böbrek taşı olan 60 hasta (60 renal ünite) çalışmaya dahil edildi. Grup I'e mikro-PNL (n:30) ve Grup II'ye RIRC (n:30) ameliyatı uygulandı. Yaş, cinsiyet, taş boyutu, skopi ve ameliyat süreleri, postoperatif yatış süreleri, preoperatif-postoperatif hemoglobin (Hb), serum kreatinin ve tahmini glomerüler filtrasyon hızı (e-GFR) değerleri, postoperatif başarı ve komplikasyon oranları yönünden gruplar birbiriyle karşılaştırıldı. Postoperatif 3. ay kontrastsız BT ile rezidü taş varlığı değerlendirildi. Bulgular: Grup I; 16 Erkek (%53,3), 14 Kadın (%46,7) olup yaş ortalaması 29,7 yıl idi. Bu grupta 18 (%60)'inde sağ böbrek, 12 (%40)'sinde sol böbrek taşı mevcuttu. Grup II; 19 Erkek (%63,3), 11 Kadın (%36,7) olup yaş ortalaması 51,8 yıl idi. Bu grupta 17 (%56,7)'sinde sağ böbrek, 13 (%43,3)'ünde sol böbrek taşı mevcuttu. Grup I de taş boyutu 10,6 (5-15) mm iken Grup II de 11,5 (7-15) mm olup istatistiki olarak anlamlı fark izlenmedi. Grup I'de skopi süresi 158,5 sn iken Grup II'de skopi süresi 26,6 sn olup istatistiki olarak anlamlı idi (P=0.001). Grup I'de hastanede yatış süresi 54,2 saat iken Grup II'de 19 saat olup istatistikî olarak anlamlı idi (P=0,001). Bunun dışında ameliyat süresi, Hb değerleri, e-GFR oranları, taşsızlık oranı, komplikasyon oranlarında istatistiki fark izlenmedi. Sonuç: Alt kaliks yerleşimli, tek ve 1,5 cm'den küçük böbrek taşı tedavisinde mikro-PNL ile RIRC benzer taş temizleme ve komplikasyon oranlarına sahip olup RIRC yapılan hastalarda skopi süresi ve hastanede yatış süresi daha kısa tespit edilmiştir.
To compare micropercutaneous nephrolithotomy (micro-PNL) and retrograde intrarenal surgery (RIRS) for the management of single renal lower calix calculi smaller than 1.5 cm with regard to postoperative success and complications. Materials and Methods: 60 patients (60 renal units) with single kidney lower calyx stones smaller than 1,5 cm were included between March 2012 and December 2015 in the study. Mikro-PNL(n=30) to group I and RIRS(n=30) to group II underwent this procedure. The two groups were compared with respect to age, gender, stone burden, fluoroscopy and operation time, hospital stay, pre-post operative hemoglobin values, creatinine and estimated glomerular filtration rate(e-GFR), values, success rate, and complications(according to the Modified Clavien classification system). The stone-free rate after 3 months postoperatively were evaluated with CT. Results: Group I; [16 boys (53.3%) and 14 girls (47.7%)], mean age was 29,7 years. In 18 (60%) patients, the stones were in the right kidneys, and in 12 (40%) patients, the stones were in the left kidneys in this group. Group II; [19 boys (63.3%) and 11 girls (36.7%)], mean age was 51,8 years. In 17 (56.7%) patients, the stones were in the right kidneys, and in 13 (43.3%) patients, the stones were in the left kidneys in this group. The mean stone burden was similar between the groups [10,6 (5-15 mm) vs 11,5 (7-15 mm), P=0.213]. The mean fluoroscopy time was required in a lower proportion of patients in the RIRC (Group II) group (158.5 vs 26,6 sec. P=0.001). The mean hospital stay was required in a lower proportion of patients in the RIRC group (54.2 vs 19 h. P=0.001). In the presence of residual stones, operation time, hemoglobin loss, e-GFR rates and complications were not significantly different in the two groups. Conclusions: The stone free rates and complications was similar between the groups at management of single renal lower calix calculi smaller than 1.5 cm. RIRS is associated with lower fluoroscopy time and hospital stay.
To compare micropercutaneous nephrolithotomy (micro-PNL) and retrograde intrarenal surgery (RIRS) for the management of single renal lower calix calculi smaller than 1.5 cm with regard to postoperative success and complications. Materials and Methods: 60 patients (60 renal units) with single kidney lower calyx stones smaller than 1,5 cm were included between March 2012 and December 2015 in the study. Mikro-PNL(n=30) to group I and RIRS(n=30) to group II underwent this procedure. The two groups were compared with respect to age, gender, stone burden, fluoroscopy and operation time, hospital stay, pre-post operative hemoglobin values, creatinine and estimated glomerular filtration rate(e-GFR), values, success rate, and complications(according to the Modified Clavien classification system). The stone-free rate after 3 months postoperatively were evaluated with CT. Results: Group I; [16 boys (53.3%) and 14 girls (47.7%)], mean age was 29,7 years. In 18 (60%) patients, the stones were in the right kidneys, and in 12 (40%) patients, the stones were in the left kidneys in this group. Group II; [19 boys (63.3%) and 11 girls (36.7%)], mean age was 51,8 years. In 17 (56.7%) patients, the stones were in the right kidneys, and in 13 (43.3%) patients, the stones were in the left kidneys in this group. The mean stone burden was similar between the groups [10,6 (5-15 mm) vs 11,5 (7-15 mm), P=0.213]. The mean fluoroscopy time was required in a lower proportion of patients in the RIRC (Group II) group (158.5 vs 26,6 sec. P=0.001). The mean hospital stay was required in a lower proportion of patients in the RIRC group (54.2 vs 19 h. P=0.001). In the presence of residual stones, operation time, hemoglobin loss, e-GFR rates and complications were not significantly different in the two groups. Conclusions: The stone free rates and complications was similar between the groups at management of single renal lower calix calculi smaller than 1.5 cm. RIRS is associated with lower fluoroscopy time and hospital stay.
Açıklama
Anahtar Kelimeler
Böbrek, Kidney, Böbrek hastalıkları, Kidney diseases, Böbrek taşları, Kidney calculi, Cerrahi tedavi, Surgical treatment
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Künye
Kandemir, A. (2016). 1.5 cm'den küçük böbrek alt kaliks taşlarının tedavisinde mikro perkütan nefrolitotomi ve retrograd intrarenal cerrahi yöntemlerinin karşılaştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Üroloji Anabilim Dalı, Konya.
