ARSLAN B, Ş. Y ÖNOL, T. DEĞİRMENCİ, Z KOZAKCIOĞLU, B. GÜNLÜSOY, T. YONGUÇ, İ. H BOZKURT

Parsiyel nefrektomi yapılan böbrek tümörlü olgularda pedikül klempajı ile parankimal klempaj uygulamalarının karşılaştırılması

Amaç: Nefron koruyucu cerrahi sırasında kanamanın engellenmesi için farklı teknikler uygulanmaktadır. Bu çalışmada parankimal klempaj ve pedikül klempajı ile yapılan parsiyel nefrektomilerin postoperatif böbrek fonksiyonuna etkilerini değerlendirmeyi amaçladık. Gereç ve Yöntem: Kliniğimizde toplam 64 hastaya sırasıyla pedikül klempajı ve parankimal klempaj tekniğiyle parsiyel nefrektomi yapıldı. Tüm hastalarda operasyon süresi, iskemi süresi, aspiratörde toplanan kan miktarı kaydedildi. Hastaların postoperatif 6. ayda kreatinin değerleri ölçüldü. Preoperatif ve postoperatif glomerüler filtrasyon oranları Modification of Diet in Renal Disease formülü ile hesaplandı. Her iki klempaj tekniği yaş, bazal metabolizma indeksi (BMI), tümör çapı, Fuhrman derecesi, iskemi zamanı, operasyon süresi, kanama miktarı, preoperatif kreatinin, postoperatif kreatinin, preoperatif GFR, postoperatif GFR değerleri açısından karşılaştırıldı. İstatistiksel analiz için Student’s t-test ve eşleştirilmiş örneklem t testi kullanıldı. Bulgular: Hastaların postoperatif kreatinin düzeylerinde artış, GFR düzeylerinde azalma görüldü. Bu bozulmalar istatistiksel olarak anlamlıydı (p0,05). Kanama miktarının parankimal klempaj tekniğinde anlamlı derecede yüksek olduğu görüldü (377±65’e karşı 243±80; p=0.001). Sonuç: Böbrek tümörü nedeniyle parsiyel nefrektomi yapılan olgularda pedikül ve parankimal klempaj teknikleri başarı ile uygulanır. Her iki yöntemde de GFR değerlerinde azalma ve kreatinin değerlerinde artış mevcuttur. Parankimal klempaj tekniği; kanama miktarının fazla olmasına rağmen pedikül diseksiyonu gerektirmediğinden avantajlı bir yöntemdir.

Comparison of pedicle clamping and parenchymal clamping in patients with renal cell carcinoma during partial nephrectomy

Aim: Different techniques are used to prevent bleeding during nephron-sparing renal surgery. In this study, our aim was to evaluate the results of partial nephrectomies performed with parenchymal clamping and pedicle clamping on postoperative renal function. Materials and Methods: The partial nephrectomy with parenchymal clamping and pedicle clamping technique was performed on 64 patients with renal cell carcinoma in our clinic. Operative time, ischemia time, and the total amount of blood loss was recorded. Creatinine levels were measured at the postoperative sixth month. Preoperative and postoperative glomerular filtration rates (GFR) were calculated using the Modification of Diet in Renal Disease formula. Patient age, basal metabolic index (BMI), tumor size, Fuhrman grade, ischemia time, operative time, amount of blood loss, preoperative and postoperative creatinine, and preoperative and postoperative GFR values were compared for both techniques. For statistical analysis, the student’s t test and paired sample t tests were used. Results: There was a statistically significant deterioration of creatinine and GFR values for both groups postoperatively (p<0.05). However, there was no statistically significant difference between the preoperative and postoperative values of creatinine and GFR values for both groups (p>0.05). The amount of blood loss was significantly higher with the parenchymal clamping technique (377±65 vs 243±80; p=0.001). Conclusion: Parenchymal and pedicle clamping techniques can be used successfully in patients undergoing partial nephrectomy for renal tumors. There is a similar reduction in GFR values and an increase in creatinin values in both techniques. Although it carries the risk of large amounts of bleeding, the parenchymal clamping technique seems more advantageous because it does not necessitate pedicle dissection.

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