Fatih BIÇAKLIOĞLU, Murat Yavuz Koparal, Ender Cem BULUT

Perkütan nefrolitotomi'ye 2. basamak devlet hastanesinde başlamak güvenli ve etkin mi?: ilk 60 vaka

GİRİŞ ve AMAÇ: Bu çalışmada uzmanlık eğitimi sonrası PNL’ye ilk kez 2. basamak devlet hastanesinde başlayan bir cerrahın bu cerrahide yetkinliğe ulaşıldığı düşünülen ilk 60 vakasının sonuçlarını retrospektif olarak değerlendirerek PNL’ye 2. basamak hastanelerinde güvenli ve etkin bir şekilde başlanabileceğini değerlendirmek amaçlandı. YÖNTEM ve GEREÇLER: Çalışmaya perkütan nefrolitotomi yapılan 60 renal ünite (58 hasta) dahil edildi. Tüm hastalara prone pozisyonda standart (30Fr) perkütan nefrolitotomi 25 Fr rijit nefroskop ve pnömotik litotriptör ile uygulandı. Yaş, cinsiyet, opere edilen taraf gibi hastaya ilişkin veriler ile birlikte taş yükü, taş sayısı, taşın lokalizasyonu, renal akses lokalizasyonu ve sayısı, operasyon süresi, postop komplikasyonlar, kan transfüzyonu gereksinimi, başarı oranı, hastanede kalış süresi ve ek tedavi gereksinimleri gibi veriler retrospektif olarak toplandı. BULGULAR: Hastaların 43 (%74) ‘ü erkek, 15 (%26)’i kadın olup yaş ortalaması 47,8 ± 10,5 (22-67) idi. Taşların 20 (%33,3)’si basit taşlarken 40 (%66,7)’ı kompleks taşlardı. Ortalama taş yükü 8,4 cm2 ve ortalama Hounsfield Ünite (HU) 1121 ± 267 idi. Ortalama ameliyat süresi 125 ± 34 dakika idi. Hastalar ortalama 4,4 ± 2 (2-12) gün hastanede yattı. %26,7 renal ünitede komplikasyon görülürken Clavien grade 4 ve 5 komplikasyon görülmedi. Ek girişimlerle birlikte %90 başarı (taşsızlık + klinik önemsiz rezidüel fragmanlar) elde edildi. TARTIŞMA ve SONUÇ: PNL’ye 2. basamak devlet hastanelerinde güvenli ve etkin bir şekilde literatürle uyumlu komplikasyon ve başarı oranları ile başlanabileceği düşünülmekte olup konu ile ilgili prospektif randomize kontrollü çalışmalara ihtiyaç vardır

Is it safe and effective to begin percutaneous nephrolithotomy in a 2nd stage state hospital? : First 60 case

INTRODUCTION: The aim of this study was to evaluate the results of the first 60 patients of a surgeon who started performing PNL for the first time in a state hospital after the residency and to evaluate that PNL can be started safely and effectively in 2nd stage hospitals. METHODS: Sixty renal units (58 patients) undergoing percutaneous nephrolithotomy were included in the study. All patients underwent standard (30Fr) percutaneous nephrolithotomy with 25 Fr rigid nephroscope and pneumatic lithotriptor in the prone position. The data was evaluated retrospectively in terms of patients age, gender, operated side and stone burden, stone number, stone localization, location and number of renal accesses, duration of operation, complications, blood transfusion requirement, success rate, hospital stay and additional treatment requirements. RESULTS: 43 (74%) of patients were male and 15 (26%) were female and the mean age was 47.8 ± 10.5 (22-67). Of the stones, 20 (33.3%) were simple stones and 40 (66.7%) were complex stones. The mean stone burden was 8.4 cm2 and the mean Hounsfield unit (HU) was 1121 ± 267. The mean operative time was 125 ± 34 minutes. The patients were hospitalized for an average of 4.4 ± 2 (2-12) days. Complications were observed in 26.7% renal unit and no Clavien grade 4 and 5 complications. 90% success (stone free + clinically insignificant residual fragments) was obtained with additional interventions. DISCUSSION and CONCLUSION: It is thought that PNL can be started with complication and success rates compatible with the literature safely and effectively in 2nd level state hospitals and prospective randomized controlled studies are needed.

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