Hamide Ayben KORKMAZ, Ahmet KARAOĞLU, İlkay CEYLAN

Vertebral Kompresyon Kırıklarının Perkütan Kifoplasti ile Tedavisinde Anestezi Yöntemlerinin Etkinliğinin Karşılaştırılması

Amaç: Kifoplasti , vertebral kompresyon kırıklarında ağrıyı hafifletmeye ve yapısal bütünlüğü güçlendirmeye yardımcı olabilen perkütan girişimsel bir prosedürdür. Bu işlem için farklı anestezi teknikleri kullanılmaktadır. Bu çalışmada PKP için ideal anestezi tekniğinin araştırılması amaçlanmıştır. Materyal ve Metot: Prospektif, randomize olmayan çalışmamız Ocak 2022-Haziran 2022 arasında gerçekleştirildi. Hastalar genel anestezi grubu, lokal anestezi grubu, epidural anestezi grubu olarak üç gruba ayrıldı. Perioperatif ağrı ve komplikasyonlar değerlendirildi. Bulgular: Merkezimizde vertebral kompresyon kırığı nedeniyle peruktan kifoplasti uygulanan 40 hasta çalışmaya alındı. Genel anestezi altında operasyon geçiren hasta sayısı çok az olduğundan ilgili hasta grubu sadece tanımlayıcı istatistiklerde gösterilip karşılaştırma istatistiklerinde değerlendirmeye alınmadı. Lokal anestezi grubunda tüm zamanlama noktalarında katlanılabilir ağrı yaşanırken %25 oranında ciddi komplikasyon yaşandı. 4 hastanın ameliyat sonrası yoğun bakım takibi ihtiyacı oldu. Epidural anestezi grubunda trokar girişi sırasında ağrı yaşanırken (ort görsel analog skala=2), diğer zamanlamalarda ağrı yaşanmadı. Komplikasyon oranı lokal anestezi grubundan düşük, yoğun bakım takip ihtiyacı yoktu. Sonuç: Epidural anestezi, peruktan kifoplasti için güvenli bir anestezi tekniğidir. Postoperatif analjezi, düşük komplikasyon oranı ve ameliyat sonrası yoğun bakım ünitesi ihtiyacı ile ilgili olarak lokal anesteziden avantajlıdır. Fakat anestezi uygulama süresi ve maliyet açısından dezavantajlıdır. Komorbidetesi yüksek, tek seviye peruktan kifoplasti operasyonlarında uygun bir anestezi tekniği olarak düşünülebilir.

Anahtar Kelimeler:

vertebral kompresyon kırığı, perkutan kifoplasti, epidural anestezi, lokal anestezi

Efficacy and safety of percutaneous nephrolithotomy in elderly patients: Experience of 128 cases

OBJECTIVE: This study aimed to evaluate the efficacy and safety of percutaneous nephrolithotomy in elderly patients (≥65 years) with kidney stones > 2 cm in size. PATIENTS AND METHODS: Patients aged ≥65 years who underwent percutaneous nephrolithotomy for kidney stones between January 2015 and January 2022 were included in this study. Patient profiles, preoperative stone data, operative information, and postoperative complications were reviewed. We applied the Guys Stone score to predict the net results of percutaneous nephrolithotomy. RESULTS: Percutaneous nephrolithotomy was performed on 128 geriatric patients. Of these patients, 68 (53.1%) were male and 60 (46.9%) were female. The mean age was 69.87 ± 7.06 (65–80) years. The mean stone size was 28.7 ± 6.5 mm (22–46 mm). The mean operative time was 90.33 ± 40.56 min and fluoroscopy time was 5.16 ± 2.81 min. The reentry catheter was removed after an average of 3.21 ± 1.82 days. The mean duration of hospital stay was 3.17 ± 2.19 days. The stone-free survival rate was 90.6%. Transfusion was performed in four (3.1%) patients due to hemorrhage, and urine extravasation from the re-entry tract occurred in eight (6.2%) patients, and this required Double j-stent placement. When the four Guys stone score groups were compared, there was a statistically significant difference in stone-free rates (p = 0.001). CONCLUSIONS: According to our results, percutaneous nephrolithotomy is a safe and effective treatment option for nephrolithiasis in the elderly, with high stone-free and acceptable complication rates.

Keywords:

Elderly patients, percutaneous nephrolithotomy, nephrolithiasis, Guys stone score,

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