18 Yaşından Küçük Pediatrik Hastalarda Uygulanan Farklı Perkütan Nefrolitotomi Prosedürlerinin Değerlendirilmesi

Amaç: Bu çalışmada kliniğimizde standart perkütan nefrolitotomi (PNL), mini perkütan nefrolitotomi (mini-PNL), ultra-mini perkütan nefrolitotomi (UMP) ve mikro perkütan nefrolitotripsi (mikro-PNL) prosedürleri uygulanan 18 yaş altı pediatrik hastaların sonuçları sunulmuştur. Gereç ve Yöntemler: Mart 2011 ile Ekim 2015 tarihleri arasında böbrek taşı tedavisi için farklı PNL prosedürleri uygulanan 18 yaş altı 272 hastanın verileri retrospektif olarak incelendi. Hastalar operasyonda uygulanan dilatasyon çapına göre standart PNL (30 Fr-24 Fr) ( Grup 1), mini-PNL (20 Fr-16 Fr) (Grup 2), UMP (14 Fr-12 Fr) (Grup 3) ve mikro-PNL (4,8 Fr) (Grup 4) şeklinde dört gruba ayrıldı. Bulgular: Böbrek taşı nedeniyle 18 yaş altı olup 73 hasta (Grup 1), 75 hasta (Grup 2), 78 hasta (Grup 3), 46 hasta (Grup 4) çalışmaya dâhil edilmiştir. Ortalama operasyon süresi; Grup 1’de 56,3±21,6 dk, Grup 2’de 49,9±15,3 dk, Grup 3’te 57,3±16,2 dk, Grup 4’te 61,7±22,6 dk şeklinde bulunmuştur (p=0,006). Skopi süresi Grup 1’de 1,7±1,1 dk, Grup 2’de 1,5±0,9 dk, Grup 3’te 2,3±1,3 dk, Grup 4’te 1,6±1,2 dk olarak hesaplanmıştır (p<0,001). Hemoglobin miktarındaki azalma Grup 1’de 1,4±1,5 gr/dL, Grup 2’de 1,1±1,2 gr/dL, Grup 3’te 0,8±0,9 gr/dL, Grup 4’te 0,5±0,9 gr/dL saptanmıştır (p<0,001). Başarı oranları karşılaştırıldığında ilk müdahale sonrası fark olsada ek müdahaleler sonrası taşsızlık oranı Grup 1’de 61 hastaya (%83,6), Grup 2’de 70 hastaya (%93,3), Grup 3’te 66 hastaya (%84,6), Grup 4’te 41 hastaya (%89,1) olarak hesaplanmıştır (p=0,093). Sonuç: Çalışmamızda 18 yaş altı pediatrik hasta grubunda farklı PNL prosedürlerinin benzer başarı ve komplikasyon oranları görülmesine rağmen; kanama miktarının UMP ve mikro-PNL’de düşük bulunmuştur. Bu yaş grubunda akses, dilatasyon ve fragmantasyon esnasında minyatür enstrümanlar kullanılarak daha düşük kanama oranı ile benzer başarı ve etkinlik sağlandığı görülmüştür.

Anahtar Kelimeler:

Perkütan nefrolitotomi, Mini-PNL, Ultra-mini PNL, Micro-PNL

Evaluation of Different Percutaneous Nephrolithotomy Procedures Applied in Pediatric Patients Under 18 Years Old

Objective: In this study, we present the results of pediatric patients under 18 years of age who underwent standard percutaneous nephrolithotomy (PNL), mini percutaneous nephrolithotomy (mini-PNL), ultra-mini percutaneous nephrolithotomy (UMP) and micro percutaneous nephrolithotomy (micro-PNL) procedures in our clinic.Material and Methods: The data of 272 patients were reviewed retrospectively who under the age of 18 and underwent different PNL procedures for the treatment of kidney stones between March 2011 and October 2015. According to the dilatation diameter applied in the operation patients were divided into four groups as standard PNL (30 Fr-24 Fr) (Group 1), mini-PNL (20 Fr-16 Fr) (Group 2), UMP (14 Fr-12 Fr) (Group 3) and micro- PNL (4.8 Fr) (Group 4).Results: 73 patients (Group 1), 75 patients (Group 2), 78 patients (Group 3) with UMP, 46 patients (Group 4) who were under 18 years of age and were included in the study due to renal stone. Mean operation time was; 56.3 ± 21.6 min in Group 1, 49.9 ± 15.3 min in Group 2, 57.3 ± 16.2 min in Group 3, 61.7 ± 22.6 min in Group 4 (p = 0.006).Duration of the scopy was 1.7 ± 1.1 min in Group 1, 1.5 ± 0.9 min in Group 2, 2.3 ± 1.3 min in Group 3, 1.6 ± 1.2 min in Group 4 (p <0.001). The decrease in hemoglobin content was 1.4 ± 1.5 gr / dL in Group 1, 1.1 ± 1.2 gr / dL in Group 2, 0.8 ± 0.9 gr / dL in Group 3, Group 4 0.5 ± 0.9 gr / dL (p <0.001).Although success rates were different result of the first intervention, after additional interventions the stone-free rate was 61 patients (83.6%) in Group 1, 70 patients (93.3%) in Group 2, and 66 patients (84.6%) in Group 3, 41 patients (89.1%) in Group 4 and we achieved to similar success rates between groups (p = 0.093).Conclusion: In our study, despite the similar success and complication rates of different PNL procedures in the pediatric patient group under 18 years; hemorrhage was lower in UMP and micro-PNL. In this age group, similar success and efficacy were obtained with lower bleeding rate by using miniature instruments during accessories, dilatation and fragmentation.

Keywords:

Percutaneous nephrolithotomy, Mini-PNL, Ultra-mini PNL, Pediatric nephrolithiasis,

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