Tansu DEĞİRMENCİ, Serkan YARIMOĞLU, Gürkan CESUR, Özgür DEYİRMENCİ, M.Bilal NART

OBEZİTENİN BÖBREK TAŞI NEDENİYLE UYGULANAN PRONE-PERKÜTAN NEFROLİTOTOMİNİN SONUÇLARI ÜZERİNE ETKİSİ

Giriş: Bu çal ışmada, böbrek taşlarında, obezitenin prone-perkütan nefrolitotominin (prone-PNL) başarı ve komplikasyonları üzerine etkisini değerlendirmeyi amaçladık. Gereç ve Yöntem: 2012 ile 2017 yılları arasında böbrek taşı nedeniyle prone-PNL uygulanan 762 hastanın dosyaları retrospektif olarak incelendi. Hastalar vucüt kitle endekslerine (VKİ) göre iki gruba ayrıldı. VKİ30 kg/mm2 olan hastalar ise Grup-2 olarak tan ımlandı. Bu iki grup arasında hastaların demografik özellikleri, perioperatif ve postoperatif sonuçları karşılaştırıldı. Operasyon sonrası >4 mm taş saptanması rezidü olarak tanımlandı. Komplikasyonlar Clavien skorlama sistemine göre sınıflandırıldı. Bulgular: Çalışmaya dahil edilen 762 böbrek ta şı olan hastan ın 629’u Grup-1’de, 133’ü ise Grup-2deydi. Hastaların ortalama VKİ’leri Grup-1 ve Grup-2 de s ırasıyla 25.0±3.0 kg/mm2 ve 33.8±3.2 kg/m² idi (p=0.001). Metabolik sendrom saptanan hasta sayısı istatiksel olarak anlamlı olarak Grup-2 de daha fazlaydı (p=0.001). Grup-1 ve Grup-2 deki ortalama ta ş büyüklüğü s ırasıyla 656.9±666.2 mm2 ve 683.2±665.0 mm2’ydi( p=0.680).Peroperatif ve postoperatif sonuçları değerlendirdiğimizde, her iki grup arasında operasyon süreleri benzerdi (p=0.263). Gruplar arasındaki flouroskopi süreleri istatistiksel olarak anlamlı olarak Grup-2 de daha uzun saptandı (p=0.047). Grup-1 ve Grup-2’deki hastaların hastanede ortalama yat ış süreleri sırasıyla3.8±2.1 gün ve 4.2±4.2 gündü(p=0.072). Gruplar aras ında ortalama hemoglobin düşüş değerleri benzer olarak saptandı (p=0.534).Postoperatif sonuçları değerlendirdiğimizde, Grup-1 de ta şsızlık % 72.0 olarak saptanırken, Grup-2 de bu oran % 76.7 idi (p=0.069). Total komplikasyon oranlarına baktığımızda ise Grup-1 de % 26.2 hastada komplikasyon saptan ırken, Grup-2’de % 30.1 hastada komplikasyon saptanmıştı (p=0.364). Clavien skorlama sistemine göre komplikasyonların alt grupları incelendiğinde ise, gruplar arasında fark olmadığı saptandı. Sonuç: Obez hastalarda da böbrek taşların tedavisinde prone-PNL etkin ve güvenilir bir tedavi yöntemi olarak kullanılabilir.

EFFECT OF OBESITY ON THE OUTCOMES OF PRONE-PERCUTANEOUS NEPHROLITOTOMY DUE TO KIDNEY STONE

Introduction:In this study, we aimed to compare the su ccess and complication rate s of prone-percutaneous nephrolithotomy (prone-PNL) according to obesity of patients for renal stones. Material and Method : Between January 2012 andDecember 2017, 76 2 patients who performed prone-PNL for renalc alculi were evaluated retrospectively. Patients were divided into two groups according to body mass index (BMI). The patients with BMI < 30 kg/mm2 and>30 kg/mm2 were defined Group-1 and Group-2, respectively. Among groups, we compared demographic characteristics, perioperative and postoperative datas. Postoperatively , >4 mm Stone was identified as residual fragment. Complications were classified according to the Clavien scoring system. Results:In our study, there were 127 and 56 patients with staghorn renal calculi in the Group-1 and Group-2, respectively. The mean body mass index (BMI) were24.5±2.7 kg/mm2 and 32.3±2.2 kg/mm2 in the Group-1 and Group-2, respectively (p=0.001). The number of patients with metabolic syndrome was also statistically significantly higher in group-2 ( p=0.001). The mean st one size were 848±302 mm2 and 1020±197 mm2 in the Group-1 and Group-2, respectively ( p=0.535). When we evaluated the peroperative and postoperative results, the operation times were similar between the two groups (p = 0.263). Duration of fluoroscopy was statistically significantlyl onger in Group-2 between the groups (p = 0.047).The mean hospitalization time of the patients was3.8 ± 2.1 days and 4.2 ± 4.2 days in Group-1 and Group-2, respectively (p = 0.072).Mean decrease of hemoglobin values were found to be similar between the groups (p = 0.534).When we evaluated the postoperative results, stone-free rates were72.0% in Gro up-1, while this rate was 76.7% in Group-2 (p = 0.069). When we look at the total complication rates, complications were detected in 26.2% of patients in Group-1 and 30.1% of patients in group-2 (p = 0.364).When the subgroups of complications were examined according to the Clavien scoring system, it was found that the complication subgroups were similar between the groups. Conclusion: Prone-PNL can be used as an effective and safe tr eatment method for renal stones in obese patients.

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