Pediatrik Hastalarda Ultrason Kılavuzluğunda Direkt Ponksiyon ile Perkütan Nefrostomi Kateteri Yerleştirilmesi

Amaç Çalışmamızda pediatrik hastalara, US kılavuzluğunda, kontrast madde ve x ışını kullanmaksızın, anestezi süresini kısaltarak perkütan nefrostomi (PN) kateterinin trokar yöntemle yerleştirilmesinin etkinliğini ve avantajlarını değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bu çalışma Eylül 2016 ve Aralık 2019 tarihleri arasında 41 hastada toplam 48 PN yerleştirilmesini kapsamaktadır. Hastaların tıbbi kayıtları retrospektif olarak incelenip anestezi ve prosedür süreleri, komplikasyonlar, hastanede kalış ve kateterizasyon süreleri, tedavi öncesi ve sonrası kan üre ve kreatin düzeyleri değerlendirildirilmiştir. Bulgular: PN yerleştirilen hastaların %36,59 u (n15) kadın, %63,41’ i (n 26) erkekti ve yaşları 1 gün ile 2100 gün (70 ay) arasında değişmekte idi. Nefrostomi kateteri yerleştirilen böbreklerin %35,42 (n 17) grade 2 hidronefroz, % 64,58inde (n31) grade 3 hidronefroz bulunmaktaydı. Tüm işlem ilk seansta başarı ile gerçekleştirildi (%100). Teknik başarıya ek olarak, serum üre, kreatinin ve lökosit düzeylerinde azaltma ile klinik başarıda gözlemlendi. Majör komplikasyonlar hiçbir olgumuzda gerçekleşmemiştir. İşlemden sonra 25 hastada (%52,08) ilk 24 saatte kendini sınırlayan hafif hematüri olmuştur. Sonuç: US eşliğinde trokar yöntemle PN sunduğu avantajlardan biri anestezi süresinin kısalması, genel anestezi ihtiyacının kalmaması dolayısı ile anesteziye bağlı birçok komplikasyonun en aza indirilmesidir. US eşliğinde trokar yöntemle PN seçilmiş hastalarda güvenilir, kolay, düşük maliyetli ve hızlı bir yöntemdir, komplikasyon oranları düşük olup başarı oranları yüksektir.

Anahtar Kelimeler:

Perkütan Nefrostomi, Ultrason Kılavuzluk, Pediatrik Hastalar

Percutaneous Nephrostomy Catheter Insertion through Ultrasound Guided Direct Punction in Pediatric Patients

Objective: In this study, we aimed to evaluate the efficiency and advantages of percutaneous nephrostomy (PN) catheter insertion through the trocar method in pediatric patients with US guidance and without using contrast matter and X-ray.Material and Methods: This study included a total of 48 PN insertions in 41 patients between September 2016 and December 2019. Medical records of the patients were retrospectively assessed and anesthesia and procedure durations, complications, hospitalization and catheterization durations, and pre and post-treatment blood urea and creatinine levels were evaluated.Results: Of the PN inserted patients, 36.59% were female (n=15) and 63.41% (n=26) male with ages changing between 1 day and 2100 days (70 months). Of the nephrostomy installed kidneys, 35.42% (n=17) had grade II and 64.58% had (n=31) grade III hydronephrosis. The whole operation was successfully performed in the first session (100%). In addition to the technical success, clinical success was also observed with the decrease in serum urea, creatinine and leukocyte levels. None of our cases had major complications. During the first 24 hours of postoperative period, 25 patients (52.08%) had self-limiting mild hematuria.Conclusion: Shortened anesthesia duration, non-requirement of general anesthesia and thus minimization of many anesthesia-related complications constitute one of the advantages provided by US-guided trocar method PN. US-guided trocar method PN is a reliable, easy, low-cost and quick method in selected patients with low rates of complication and high rates of success.

Keywords:

Percutaneous Nephrostomy, Ultrasound Guided, Pediatric Patients,

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