Mehmet Hanifi OKUR, Mehmet Şerif ARSLAN, BAHATTİN AYDOĞDU, SERKAN ARSLAN, İBRAHİM UYGUN, ABDURRAHMAN ÖNEN, Selçuk OTÇU

Çocuklarda başlangıç perkütan nefrolitotomi deneyimimiz

Amaç: Mart 2012 ve Kasım 2013 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Çocuk Cerrahisi Kliniğinde çocuk yaş grubunda yapılan perkütan nefrolitotomi (PNL) deneyimlerimizi sunmaktır. Yöntemler: On üç böbrek ünitesine (12 hasta) PNL uygulandı. Hastalar, yaş, ameliyat öncesi idrar, idrar kültürü, tam kan sayımı, serum biyokimyası, rutin koagülasyon ile radyolojik tetkikler, taş yerleşimi, taş yükü (direk grafiye göre), operasyon öncesi nefrostomi kullanımı, ortalama floroskopi süresi yönünden değerlendirildi. Nefrostomi traktından erişim mekanik dilatasyon sonrası sağlandı. PNL prosedürü sonrası hastalar, rezidü (>4 mm), komplikasyonlar (Clavien sınıflamasına göre) ve tedavi sonuç- ları yönünden değerlendirildi. Tüm hastalara postoperatif nefrostomi yerleştirildi. Bulgular: Hastaların yaş ortalamaları 11(6-14) yıl olarak saptandı. Laboratuar testleri normal idi. Taşların 11i pelvis renalis, 2si pelvis + kaliks yerleşimliydi. Ortalama taş boyutu 260 mm2 idi. 10 renal üniteye intraoperatif, 3 renal üniteye preoperatif renal giriş sağlandı. Ortalama floroskopik manipülasyon süresi 4,8 dakika (2-11) idi. Post operatif 1 günde taşsızlık oranı %85 idi. Komplikasyonlar toplam 3 hastada görüldü; bir hastada renal erişim sağlanamadı (Grade 3b), bir hastada ameliyat esnasında işlem sonunda pelvis ekstravazasyonu görüldü (Grade 3a). Bir hastada post op transfüzyon gerekti (Grade 2). Ortalama hastanede yatış süresi 5.5 gün (5-7 gün) idi. Sonuç: Pediatrik PNL işlemi, yüksek taşsızlık oranı, belirgin estetik üstünlük ve minimal invaziv cerrahi girişim sağlar. Yeterli donanım ve ekipmanın bulunduğu çocuk cerrahi kliniklerinde deneyimli kişiler tarafından, PNL prosedürü kolaylıkla kullanılabilir

Our initial experience with percutaneous nephrolithotomy in children

Objective: To present our initial experience on percutaneous nephrolithotomy (PCNL) in children between March 2012 and November 2013. Methods: 13 renal units of 12 patients underwent PCNL. Patients were evaluated in terms of age, preoperatively in terms of urine, blood count, urine culture, serum biochemical, and routine coagulation tests and radiological examinations, stone location, stone burden (according to plain radiograph), preoperative use of nephrostomy and average fluoroscopic manipulation time. To facilitate access, prior mechanical dilatation was performed nephrostomy access tract. After the PCNL procedure, we placed nephrostomy in all patients postoperatively. They were evaluated with regard to residual stone, complications (according to the Clavien classification) and outcomes. Results: Average age was 11 years (6-15). There was no abnormality in Laboratory Screening. Location of 11 stones was renal pelvis and 2 stones was pelvis + calyx. The average stone size was 260 mm². Preoperative acces were provided in 3 patients, others were intraoperatively. Average fluoroscopic manipulation time was 4,8 minutes (2-11). At the first postoperative day, 11 (85 %) patients achieved a completely stone-free state. Complications were seen in 3 patients; failure of renal access in one patient (Grade 3b), urine leakage was observed after surgery in one (Grade 3a), postoperative blood transfusion required in one patient (Grade 2). The hospital stay duration was 5,5 days (5-7 days). Conclusion: Pediatric PCNL is a minimal invasive procedure which provides high rate of stone free and good cosmetics. İf there is adequate facilities and equipment with experienced persons, this procedure can easily be used in pediatric surgery clinics.

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