Böbrek taşlarının cerrahi tedavisinde ultra-mini perkütan nefrolitotomi

Abstract

Amaç: Böbrek taşlarının tedavisinde ultra-mini perkütan nefrolitotominin (UMP) etkinlik ve güvenilirliğini saptamak.Materyal-Metod: Ekim 2014- Mayıs 2015 tarihleri arasında UMP yapılan 35 hastanın demografik verileri ve operatif verileri prospektif olarak kaydedildi. Tüm hastalarda standart olarak floroskopi altında toplayıcı sistemine giriş yapıldıktan sonra trakt tek aşamalı olarak 13Fr.'e kadar dilate edildi. 3.5 Fr. optik ile toplayıcı sisteme girilip taş bulundu ve Holmiyum lazer probu ile taş fragmantasyonu sağlandı. Kırılan taş parçaları salin infizyon yardımıyla veya basket ile dışarı alındı. İşlem tüpsüz olarak veya 10 Fr. feeding tüp konularak sonlandırıldı.Bulgular: Otuz beş hastanın ortalama yaşı 34.79 (2-83) yıl ve vücut kitle indeksi 26.13 (17.6-32.8) kg/m2 idi. Ortalama taş boyutu 26.1 mm (10-50) idi.Çalışmaya alınan olguların üç tanesinde soliter böbrek, iki tanesinde at nalı böbrek ve 2 tanesinde de divertikül taşı mevcuttu. Otuz iki (%91.5) hastaya tek akses yapılırken 3 (%8.5) hastada ikinci aksese ihtiyaç duyuldu. Taşlar sırasıyla 10 hastada izole pelvis taşı, 10 hasta da izole alt kaliks taşı, 4 hastada pelvis + multiple kaliks taşı, 5 hastada parsiyel koraliform taş, 4 hastada pelvis + alt kaliks taşı ve 2 hastada da divertikül taşı şeklinde dağılım göstermekteydi. Ortalama operasyon süresi 82 dk.(30-180), ortalama skopi süresi 93.6 sn. (9-225), ortalama hemoglobin düşüşü 0.6 g/L olup hiçbir hastada kan transfüzyonuna gerek olmadı. Postoperatif 12. saat VAS (ağrı değerlendirme çizelgesi) değeri ise 2 (0-6) olarak tespit edildi. Postoperatif 2 hastada perkütan giriş yerinden ıslatma olması nedeniyle üreteral stent, 1 hastada da hidrotoraks gelişmesi nedeniyle toraks tüpü takıldı. Ortalama hastanede kalış süresi 2.3 gün (1-7) idi. Postoperatif birinci ay değerlendirmesinde 32 (%91.4) hastanın tamamen taşsız olduğu tespit edildi.

Objective: To determine efficiency and reliability of the ultra-mini percutaneous nephrolithotomy (UMP) for the treatment of renal stones.Materials and Methods: A total of 35 patients who had UMP between October 2014-May 2015 was included to study with their demographic and operative datas prospectively. All patients performed after the standard introduction to the collecting system under fluoroscopy tract was dilated up to 13F in one stage. With 3,5 Fr. optic were entered into collecting system and found the stone and provided stone fragmentation with Holmium laser probe. The broken pieces of stone taken out with saline infizyo or with the help of basket. The process was terminated by tubeless or placing 10 Fr feeding tubes.Findings: Thirty-five patients has a mean age of 34.79 (2-83) years and body mass index 26.13 (17.6-32.8) kg /m2. Mean stone size was 26.1 mm (10-50). Three of them was solitary kidney patients in the study, and there were also two diverticulum stone and two of them had horseshoe kidney. Thirty-two (91.5%) patients had a success with a single akses while 3 patients (8.5%) was required in the second akses. Respectively there were 10 patients with isolated pelvic calculi, 10 patients with isolated lower calyx stones, 4 patients hade the pelvis and multiple calyx stones, 5 patients with partial choraliform stone, 4 patients with the pelvis and lower calyx stones and in two patients stones was in the diverticulum. Mean operation time was 82 min. (30-180), the average fluoroscopy time of 93.6 seconds (9-225), mean hemoglobin decrease of 0.6 g/L and blood transfusion is not necessary in any patients. (pain assessment chart) was detected 2 (0-6). Two postoperative ureteral stent was placed due to the wetting of the percutaneous access site and there was a patient with chest tube was inserted because of the development of hydrothorax. The average hospital stay was 2.3 days (1-7). In the first postoperative month assessment 32 (91.4%) patients were found completely stone free. Results: Ultra-mini PNL is an safe, effective and feasible method especially in the treatment of mid-sized kidney stones with high stone-free and low complication rates.