Supin perkütan nefrolitotomi ile prone perkütan nefrolitotomi sonuçlarının karşılaştırılması
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışma perkütan nefrolitotomi yapılmış hastaların demografik verilerini, geçmiş tıbbı öykülerini, preop ve postop kan değerlerini, taş özelliklerini, komplikasyonları, hospitalizasyon sürelerini ve cerrahi etkinliği operasyon pozisyonuna göre karşılaştırmayı amaçlamıştır. Materyal ve Method: Bu çalışmaya 2020-2023 yılları arasında İnönü üniversitesi Turgut Özal Tıp Merkezi Üroloji kliniğimizde perkutan nefrolitotomi (PNL) operasyonu yapılan 200 hasta dahil edilmiştir. Supin ve prone pozisyon olmak üzere hastalar operasyonun gerçekleştirildiği hasta pozisyonuna göre iki gruba ayrılmıştır. Her iki gruba 100'er hasta dahil edilmiştir. Gruplar arası yaş, cinsiyet, cerrahi öykü, ek komorbiditeler, renal anomaliler, taş yüzey alanları,taş lokasyonu,ASA skoru,preop DJ stent uygulaması,nefrostomi uygulanması, hemoglobin, lökosit, trombosit,kreatinin, komplikasyon gelişimi, vaka süresi,skopi süresi,nefroskop boyutu,eritrosit süspansiyon ihtiyacı,postop ateş varlığı,rezidü taş varlığı,ek cerrahi girişim ihtiyacı,böbrek taraf bilgisi,pozisyon bilgisi,sheat boyutu, Guy's Stone Skorlaması, Houns-Field Üniti, PNL çeşidi, puncture bölgesi, hospitalizsyon süresi parametrelerindeki farklılıklar retrospektif olarak değerlendirilmiştir. Çalışmamıza pre-operatif ve post-operatif takip ve tedavileri kliniğimizde düzenlenen hastalar dahil edilmiştir. Postoperatif dönemde kontrole gelmeyen hastalar ile tüm verilerine ulaşılamayan hastalar çalışmadan çıkarılmıştır. Bulgular: Gruplar arası demografik veriler karşılaştırıldığında yaş, cinsiyet, ek hastalıklar, ASA skorları ve renal anomali varlığı parametrelerinde istatiksel farklılık izlenmemiştir(p>0,05). Geçirilmiş cerrahi öyküsü anlamlı farklıdır(p<0,05). Prone PNL hastalarında daha önce cerrahi girişim yapılmış hasta oranı daha fazla tespit edilmiştir. Gruplar arası pre-operatif taş özellikleri karşılaştırmasında taşların sahip olduğu Houns-Field Ünite açısından gruplar arası anlamlı farklılık izlenmemiştir (p>0,05). Taş lokalizasyonu, taş yüzey alanı parametreleri ise anlamlı farklılık içermektedir (p<0,05). Guy Stone Score (GSS) sınıflamasına göre anlamlı fark tespit edilmiştir. Gruplar arası intra-operatif ve post-operatif parametrelerdeki farklılıkların karşılaştırmasında; kullanılan sheat, puncture bölgesi, taş lokalizasyonu, post-op nefrostomi parametrelerinde anlamlı farklılık görülmüştür(p<0,05). Operasyon öncesinde hastalara DJ stent uygulanması ve operasyon sonunda DJ stent kullanımı oranlarında anlamlı farklılık tespit edilmemiştir (p>0,05). Gruplar arası preop kreatinin, lökosit, trombosit değerlerinin postop değerleriyle karşılaştırıldığında benzer değişimler görülüp anlamlı fark izlenmemiştir (p>0,05). Operasyon sonrası hemoglobin düşüş oranını farkı ise anlamlı tespit edilmiştir (p<0,05). Gruplar arası postop komplikasyon gelişimi, operasyon sonrasında rezidü taş varlığı, hemoglobin düşüşüne bağlı kan desteği ihtiyacı, vakada kullanılan skopi süresi değerlerinde anlamlı fark izlenmemiştir (p>0,05). Operasyon süresi ve hospitalizasyon süresi parametrelerinde ise supin PNL lehine anlamlı fark izlenmiştir (p<0,05). Lojistik regresyon modelinde anlamlı çıkan parametreler ise hastaların daha önce geçirilmiş PNL öyküsü varlığı, alt polden puncture sayısı, taşın orta pol lokalizasyonlu olması ve postop nefrostomi uygulanması olarak bulunmuştur. Sonuç: Perkütan nefrolitotomi ameliyatı hem prone hem de supin pozisyonda güvenle tercih edilebilecek bir taş cerrahisidir. Cerrahın tecrübesi pozisyon tercihi için çok önemli ve yönlendiricidir. Üst pol ve orta pol taşı olan hastalarda prone pozisyon taşlara ulaşım ve taşsızlık sağlama açısından daha fazla öne çıkmaktadır. Hospitalizasyon ve operasyon sürelerinde ise supin perkütan nefrolitotomi daha avantajlı görünmektedir. Supin pozisyonun eş zamanlı olarak endoskopik girişime de olanak vermesi (ECIRS) bu durum için çok etkili görünmektedir. Her iki yöntem için de komplikasyon oranları ve rezidü taş görülme sıklığı benzer tespit edilmiş olup cerrahi başarı ve güvenilirlik açısından birbirlerine üstünlükleri görülmemiştir. Kardiyak ve pulmoner hastalıkların nüfus içinde artması nedeniyle supin perkütan nefrolitotominin ilerleyen yıllarda kliniğimizde olduğu gibi tüm dünyada daha da öne çıkan ve tercih edilen bir cerrahi prosedür olacağını düşünmekteyiz. Anahtar kelimeler: supine perkütan nefrolitotomi, prone perkütan nefrolitotomi, taşsızlık oranı
Objective: This study aimed to compare the demographic data, past medical histories, preoperative and postoperative blood values, stone characteristics, complications, hospitalization durations, and surgical efficacy among patients who underwent percutaneous nephrolithotomy based on the operative position. Materıal and Method: This study included 200 patients who underwent percutaneous nephrolithotomy (PNL) operations at the Urology Clinic of İnönü University Turgut Özal Medical Center between 2020 and 2023. Patients were divided into two groups based on the operative position: supine and prone. Each group consisted of 100 patients. Differences between the groups in terms of age, gender, surgical history, additional comorbidities, renal anomalies, stone surface areas, stone locations, ASA score, preoperative DJ stent application, nephrostomy application, hemoglobin, leukocyte, platelet, creatinine levels, development of complications, case duration, scope duration, nephroscope size, need for erythrocyte suspension, presence of postoperative fever, presence of residual stones, need for additional surgical interventions, kidney side information, position information, sheath size, Guy's Stone Scoring, Hounsfield Units, type of PNL, puncture site, and hospitalization duration parameters were retrospectively evaluated. Patients who did not attend follow-up visits during the postoperative period and those whose data could not be accessed were excluded from the study. Fındıngs: When comparing demographic data between groups, no statistical differences were observed in age, gender, additional diseases, ASA scores, and the presence of renal anomalies (p>0.05). However, a significant difference was found in the history of previous surgeries (p<0.05), with a higher rate of previous surgical interventions noted in prone PNL patients. Regarding the comparison of preoperative stone characteristics between groups, no significant differences were observed in terms of Hounsfield Units (p>0.05). However, significant differences were found in stone localization and stone surface area parameters (p<0.05). Significant differences were also detected based on the Guy Stone Score (GSS) classification. In comparing intraoperative and postoperative parameters between groups, significant differences were observed in the use of sheaths, puncture sites, stone localization, and postoperative nephrostomy parameters (p<0.05). There were no significant differences in the rates of preoperative DJ stent application and postoperative DJ stent usage between groups (p>0.05). When comparing preoperative creatinine, leukocyte, and platelet values with their postoperative values between groups, similar changes were observed with no significant differences (p>0.05). However, a significant difference was found in the rate of postoperative hemoglobin decrease (p<0.05). No significant differences were observed between groups in terms of postoperative complication development, presence of residual stones postoperatively, need for blood support due to hemoglobin decrease, and scope duration used in the case (p>0.05). However, significant differences were noted in operation duration and hospitalization duration parameters, favoring supine PNL (p<0.05). Significant parameters identified in the logistic regression model included the history of previous PNL, the number of punctures from the lower pole, stone localization in the middle pole, and postoperative nephrostomy application. Conclusion: Percutaneous nephrolithotomy (PNL) surgery can be safely preferred in both prone and supine positions for stone management. The surgeon's experience plays a crucial role in determining the preferred position. Prone position stands out more in accessing stones and achieving stone clearance, especially in patients with upper pole and middle pole stones. However, supine PNL appears to be more advantageous in terms of hospitalization and operation durations. The ability of the supine position to allow simultaneous endoscopic procedures (ECIRS) seems highly effective in this regard. Complication rates and the frequency of residual stones are similar for both methods, with no superiority observed in terms of surgical success and reliability. Considering the increasing prevalence of cardiac and pulmonary diseases in the population, we believe that supine PNL will become a more prominent and preferred surgical procedure not only in our clinic but also worldwide in the coming years. Key words : supine percutaneus nefrolitotomi, prone percutaneus nefrolitotomi, stone free rate
Objective: This study aimed to compare the demographic data, past medical histories, preoperative and postoperative blood values, stone characteristics, complications, hospitalization durations, and surgical efficacy among patients who underwent percutaneous nephrolithotomy based on the operative position. Materıal and Method: This study included 200 patients who underwent percutaneous nephrolithotomy (PNL) operations at the Urology Clinic of İnönü University Turgut Özal Medical Center between 2020 and 2023. Patients were divided into two groups based on the operative position: supine and prone. Each group consisted of 100 patients. Differences between the groups in terms of age, gender, surgical history, additional comorbidities, renal anomalies, stone surface areas, stone locations, ASA score, preoperative DJ stent application, nephrostomy application, hemoglobin, leukocyte, platelet, creatinine levels, development of complications, case duration, scope duration, nephroscope size, need for erythrocyte suspension, presence of postoperative fever, presence of residual stones, need for additional surgical interventions, kidney side information, position information, sheath size, Guy's Stone Scoring, Hounsfield Units, type of PNL, puncture site, and hospitalization duration parameters were retrospectively evaluated. Patients who did not attend follow-up visits during the postoperative period and those whose data could not be accessed were excluded from the study. Fındıngs: When comparing demographic data between groups, no statistical differences were observed in age, gender, additional diseases, ASA scores, and the presence of renal anomalies (p>0.05). However, a significant difference was found in the history of previous surgeries (p<0.05), with a higher rate of previous surgical interventions noted in prone PNL patients. Regarding the comparison of preoperative stone characteristics between groups, no significant differences were observed in terms of Hounsfield Units (p>0.05). However, significant differences were found in stone localization and stone surface area parameters (p<0.05). Significant differences were also detected based on the Guy Stone Score (GSS) classification. In comparing intraoperative and postoperative parameters between groups, significant differences were observed in the use of sheaths, puncture sites, stone localization, and postoperative nephrostomy parameters (p<0.05). There were no significant differences in the rates of preoperative DJ stent application and postoperative DJ stent usage between groups (p>0.05). When comparing preoperative creatinine, leukocyte, and platelet values with their postoperative values between groups, similar changes were observed with no significant differences (p>0.05). However, a significant difference was found in the rate of postoperative hemoglobin decrease (p<0.05). No significant differences were observed between groups in terms of postoperative complication development, presence of residual stones postoperatively, need for blood support due to hemoglobin decrease, and scope duration used in the case (p>0.05). However, significant differences were noted in operation duration and hospitalization duration parameters, favoring supine PNL (p<0.05). Significant parameters identified in the logistic regression model included the history of previous PNL, the number of punctures from the lower pole, stone localization in the middle pole, and postoperative nephrostomy application. Conclusion: Percutaneous nephrolithotomy (PNL) surgery can be safely preferred in both prone and supine positions for stone management. The surgeon's experience plays a crucial role in determining the preferred position. Prone position stands out more in accessing stones and achieving stone clearance, especially in patients with upper pole and middle pole stones. However, supine PNL appears to be more advantageous in terms of hospitalization and operation durations. The ability of the supine position to allow simultaneous endoscopic procedures (ECIRS) seems highly effective in this regard. Complication rates and the frequency of residual stones are similar for both methods, with no superiority observed in terms of surgical success and reliability. Considering the increasing prevalence of cardiac and pulmonary diseases in the population, we believe that supine PNL will become a more prominent and preferred surgical procedure not only in our clinic but also worldwide in the coming years. Key words : supine percutaneus nefrolitotomi, prone percutaneus nefrolitotomi, stone free rate
Açıklama
Tıp Fakültesi, Üroloji Ana Bilim Dalı
Anahtar Kelimeler
Üroloji, Urology
