Volkan TUĞCU, Ramazan KOCAKAYA, Abdülmüttalip ŞİMŞEK, SELÇUK ŞAHİN, Buğra Doğukan TÖRER, Taner KARGI, Ali İhsan TAŞÇI

Pediatrik taş hastalarında Mini-perc'' deneyimlerimiz

Amaç: Bu çalışmada staghorn (komplet veya parsiyel ) ve böbrek pelvis taşları olan pediatrik yaş grubundaki hastalara uyguladığımız miniperkütan nefrolititomi sonuçlarımız sunulmuştur. Hastalar ve Yöntem: Kliniğimizde Haziran 2008 ve Ocak 2013 tarihleri arasında, yaş- ları 3 ile 13 arasında değişen, 36 hasta (kız:16, erkek:20) böbrek taşı nedeni ile miniperc ile tedavi edildi. Onüç hastada (36,1%) komplet staghorn, on hastada (27,8%) parsiyel staghorn onüç hastada (36,1%) pelvis taşları mevcuttu. Ortalama taş yükü 192 mm² ( 96-310 mm² ) idi. Bütün girişimler 22 f sheath içinden yapıldı. Skopi altında tek giriş ile toplayıcı sisteme girilerek, kılavuz tel üzerinden dilatasyon işlemi gerçekleştirildi. İşlem sırasında pnömatik litotriptör ve Holmiyum:Yag lazer kullanıldı. Ulaşılamayan kaliks taşlarına fleksibl nefroskop ile müdahele edildi. 26 hastaya 10F nefrostomi tüpü, 10 hastaya ise 14F nefrostomi tüpü yerleştirildi. Bulgular: Ortalama operasyon zamanı 82 dk (44-112 dk), Ortalama hematokrit değerlerindeki düşüş %3,1 düzeyindeydi ve hiçbir hastaya kan transfüzyonu yapılmadı. Nefrostominin çekilme süresi 29 (18-36) saatti. Ortalama hastanede kalış süresi 2.3 ( 1,5-3 gün) gündü. 30 (%83,3) hastada taşsızlık sağlandı. 6 (%16,7) hastada kalan rezidüel taşlar ESWL yöntemi ile tedavi edildi. Olguların hiç birinde bir komplikasyon gözlenmedi. Sonuç: Pediatrik yaş grubu hastalarda mini-perkütan nefrolitotomi etkili ve güvenli bir şekilde kullanılabilir

Our miniperc experiences in children

Purpose: We present our experience with mini percutaneous nephrolithotomy (miniperc) for staghorn (complet or partial) and renal pelvic calculi in children. Patıents and Methods: Between June 2008 and January 2013, 36 patients (20 boys and 16 girls), aged 3 and 13 years-old, were treated with miniperc because of renal stone in our clinic. There were complet staghorn calculi in 13 patients, partial staghorn calculi in 10 patients and renal pelvic calculi in 13 patients. The average bulk of the stones was 192 mm² (range: 96-310 mm²). All procedures have been performed with the 22 f sheath. Tract dilation and insertion of the sheath into the collecting system was performed with a single pass over an access wire under x ray scopy. Operation was performed using pneumatic lithotriptor and Holmiyum:Yag laser. Unreachable caliceal stones were reached and fragmanted with the help of flexible nephroscope. We put 10 f nephrostomy tubes to 26 patients and 14 f nephrostomy tubes to 10 patients. Results: Mean procedure time was 82 minutes, mean decreasing of hematocrit values was % 3,1, and length of hospitalization was 2.3 days, respectively. 30 (83,3%) of 36 patients are currently stone free. Six patients (%16,7), had residual calcules were treated with ESWL. No patient required transfusion, developed urosepsis, or had a procedure-related complication. Conclusıons: Mini -percutaneous nephrolithotomy is safe and effective in children, and should be considered a viable management option.

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