Taşa bağlı üst üriner sistem obstrüksiyon tedavilerinin sintigrafik değerlendirilmesi
Küçük Resim Yok
Tarih
2000
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Cilt Başlığı
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Günümüzde üst üriner sistem taşlarının tedavisinde cerrahi ve ESWL önemli bir tedavi yöntemidir. Radyonuklid çalışmalar, takibinde kolay uygulanabilen noninvaziv, güvenilir tetkiktir. Biz çalışmamız da üst üriner sistem taşlarına yapmış olduğumuz tedavileri sintigrafîk açıdan değerlendirdik. Kliniğimizde üst üriner sistem taşı tespit edilen ortalama 43,5 yaşında olan 20 hasta çalışmaya dahil edilmiştir. Taşların 11' i pelviste, 9' u üreterde idi. Tedavi olarak 12' sine ESWL 8' ine Açık Cerrahi uygulandı. Hastalara tedavi öncesi Tc 99 m- DTP A, Tc 99 m- DMSA, tedavinin erken döneminde Tc 99 m - DTPA, ve tedavinin tamamlanmasından 2 ay sonra Tc 99m-DTPA ve Tc 99m - DMSA yapıldı. Etkilenen ve sağlam böbreklerin glomerüler fîltrasyon hızı ( GFR), maksimum konsantrasyon zamanı ( Tmax), eksresyon zamanı ( t Vı), perfuzyon indeks oranı (PI), splite fonksiyon oranı kantitatif olarak değerlendirildi. Sonuç olarak etkilenen böbrek GFR düzeyi ortalama tedavi öncesi ( 27,69 ± 12,72 ml/dk) iken tedavi sonrası; erken dönemde ( 28,17 ± 12,25 ml/dk) geç dönemde ise ( 33,28 ± 13, 97 ml/dk) bulundu. Buradaki artış istatistiksel açıdan anlamlıydı ( p< 0,05). Tedavi öncesi t 14 düzeyi (18, 49 ± 6,33 dk) iken tedavi sonrası; erken dönemde (12, 78± 4,35 dk), geç dönemde ise ( 9,32± 3,82 dk) bulundu. Tüm çalışmalarda azalma anlamlı idi (p<0,05). t Vı düzeyindeki azalma obstrüksiyonun ortadan kaldırıldığını ve tedavi yöntemlerinin efektif olduğunu gösterdi. Etkilenen böbreğe ait Tmax, splite, PI' de rölatif değişiklikler olmasına rağmen istatistiksel olarak anlamlı bulunmadı (p>0.05). Sağlam böbreğe ait tüm değerlerde çalışma öncesi ve sonrasında anlamlı farklılık yok idi.(p>0.05). ESWL ile Açık Cerrahi grup karşılaştırıldığında GFR ve 1 1/2 düzeylerinde iki grup arasında farklılık mevcut idi(p<0.05). ESWL çalışma grubunun GFR değerlerindeki artışın daha iyi olması; fonksiyon kayıplarının açık cerrahi grubuna göre daha az olmasına bağlı idi. Böbrek ve ureter taşlarının sintigrafîk değerlendirilmesinin karşılaştırılmasında ise önemli farklılık tesbit edilmemiştir (p>0.05). Sonuç olarak; taşa bağlı obstrüktif böbrek hastalıklarında, tedavi öncesi ve tedavi sonrası renal fonksiyonların takibinde radyonuklid çalışmalar; bir ürolog için güvenilir, kolay uygulayabileceği bir tetkiktir.
In our days surgery and ES WL play an important role in management of upper urinary tract stones. Radionuclied studies are dependable investigations in renal function evaluation and follow up and are noninvasive and easly applicable. In our study we do sintigraphic evaluations for patients who are treated for their upper urinary tract stones. Our study included 20 patients with mean age of 43.5 years. From these 20 patients 1 1 had pelvic stones and 9 had ureteric stones. As a management, ESWL was applied to 12 of them and open surgery was done to the remaining 8 patients. Before the management Tc99-m DTPA, Tc99-m DMSA ; at early stages of management Tc99-m DTPA and two months after management Tc99-m DTPA and Tc99-m DMSA was applied to the patients. The Glomerular filtration rate (GFR), Maximum concentration time (Tmax), Excreation time (tl/2), Perfusion index time (PI) and Splite function rate of the affected and healthy kidneys are quantitatively evaluated. As a result the GFR level of the affected kidney before mean management was (27,69±12,72 ml/dk ), while at early stages after the treatment was (28,17±12.2 ml/dk ) and at later stages was (33,28+ 13,97 ml/dk). This increased was significant in the statistically(p<0.05). Before the management 1 14 levels was (18,49±6,33 dk. ) while at early stages after the management was (12,78±4,35 dk. ) and later stages was (9,32±3,82 dk.). In all the studies the decrease was significant (p<0.05). The decrease in tl/2 levels was show the effectiveness of the management and releaving of the obstruction. Inspite of the variation in the affected kidney related Tmax, Splite, and PI there was no any statistical significancy(p>0.05). There was no any significant difference in the healthy kidney related values before and after the treatment (p>0.05) When we compared ESWL and open surgery there was a difference between GFR and tl/2 levels between the two groups(p<0.05). The increase in GFR of ESWL study group was better than that of open surgery group. While there is no any significant difference in the sintigraphic values between pelvic and ureteric stones group(p>0.05) A result, radyonuclied studies is very dependable and easely applicable method in renal function follow up before and after treatment in the patients with stone related obstructive renal disease.
In our days surgery and ES WL play an important role in management of upper urinary tract stones. Radionuclied studies are dependable investigations in renal function evaluation and follow up and are noninvasive and easly applicable. In our study we do sintigraphic evaluations for patients who are treated for their upper urinary tract stones. Our study included 20 patients with mean age of 43.5 years. From these 20 patients 1 1 had pelvic stones and 9 had ureteric stones. As a management, ESWL was applied to 12 of them and open surgery was done to the remaining 8 patients. Before the management Tc99-m DTPA, Tc99-m DMSA ; at early stages of management Tc99-m DTPA and two months after management Tc99-m DTPA and Tc99-m DMSA was applied to the patients. The Glomerular filtration rate (GFR), Maximum concentration time (Tmax), Excreation time (tl/2), Perfusion index time (PI) and Splite function rate of the affected and healthy kidneys are quantitatively evaluated. As a result the GFR level of the affected kidney before mean management was (27,69±12,72 ml/dk ), while at early stages after the treatment was (28,17±12.2 ml/dk ) and at later stages was (33,28+ 13,97 ml/dk). This increased was significant in the statistically(p<0.05). Before the management 1 14 levels was (18,49±6,33 dk. ) while at early stages after the management was (12,78±4,35 dk. ) and later stages was (9,32±3,82 dk.). In all the studies the decrease was significant (p<0.05). The decrease in tl/2 levels was show the effectiveness of the management and releaving of the obstruction. Inspite of the variation in the affected kidney related Tmax, Splite, and PI there was no any statistical significancy(p>0.05). There was no any significant difference in the healthy kidney related values before and after the treatment (p>0.05) When we compared ESWL and open surgery there was a difference between GFR and tl/2 levels between the two groups(p<0.05). The increase in GFR of ESWL study group was better than that of open surgery group. While there is no any significant difference in the sintigraphic values between pelvic and ureteric stones group(p>0.05) A result, radyonuclied studies is very dependable and easely applicable method in renal function follow up before and after treatment in the patients with stone related obstructive renal disease.
Açıklama
Anahtar Kelimeler
Radyonüklid görüntüleme, Radionuclide imaging, Üreter tıkanmaları, Ureteral obstruction, Üriner taşlar, Urinary calculi
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Selçuk, A. (2000). Taşa bağlı üst üriner sistem obstrüksiyon tedavilerinin sintigrafik değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Üroloji Anabilim Dalı, Konya.
