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Üst kaliks taşları olan hastalarda subkostal giriş tekniği ile perkütan nefrolitotomi sonuçları

Results of percutaneous nephrolitotomy with subcostal approach in patients with upper calyces stones

Journal Name:

  • Gülhane Tıp Dergisi

Publication Year:

  • 2009

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Abstract (2. Language): 
In this study, we aimed to present the results of subcostal percutaneous nephrolitotomy operation in patients with upper calyces stone. The operation records of 44 patients who had undergone subcostal percutaneous nephrolitotomy for upper calyces stone were retrospectively evaluated. The situations of stone-free and clinically insignificant residual fragments (<4 mm and not causing obstruction) were accepted as success. The mean age of the patients was 44 (7–71) years, and the mean stone load was 805 (120–2240) mm². Of the 44 patients, 18 (42.3%) had isolated upper calyces stone and 26 (59.09%) had complex renal pelvis stones including upper and lower calyceal systems. Single and double accesses were performed in 38 (86.3%) and 6 (13.6%) of the patients, respectively. Of a total of 50 renal accesses, 18 (36%) were performed to middle and upper pole with a subcostal-triangulation technique and 32 (64%) were performed to lower and/or middle pole with a subcostal-direct technique. The situations of stone-free and clinically insignificant residual fragments were detected in 27 (61.3%) and 8 (18.1%) of the patients, respectively. Regarding complications, blood transfusion was required in 11 (25%) patients and hydropneumothorax developed in one (2.2%) patient. We conclude that a success rate of about 80% may be achieved with subcostal approach in selected patients with upper calyces stones especially by urologists who have little experience of percutaneous surgery.
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Abstract (Original Language): 
Bu çalışmada, üst kaliks taşı olan hastalarda subkostal perkütan nefrolitotomi operasyonunun sonuçlarını sunmayı amaçladık. Üst kaliks taşı tedavisi için subkostal perkütan nefrolitotomi geçirmiş 44 hastanın operasyon kayıtları geriye dönük olarak incelendi. Taştan arınma ve klinik önemsiz taş parçası (<4 mm ve obstrüksiyona yol açmayan) başarı olarak kabul edildi. Ortalama hasta yaşı 44 (7–71) yıl ve ortalama taş yükü 805 (120–2240) mm² idi. Kırk dört hastanın, 18’inde (%42.3) izole üst kaliks taşı, 26’sında (%59.09) üst ve alt kaliks sistemlerini de içeren karmaşık pelvis taşları vardı. Otuz sekiz (%86.3) hastada tek giriş, 6 hastada (%13.6) çift giriş yapılmıştı. Toplam 50 böbrek girişinin, 18’i (%36) subkostal-triangülasyon tekniği ile orta ve üst pole, 32’si ise (%64) subkostal-direkt olarak alt ve/veya orta pole yapılmıştı. Hastaların 27’sinde (%61.3) taştan arınma, 8’inde ise (%18.1) klinik önemsiz taş parçası durumu belirlendi. Komplikasyonlar açısından, 11 (%25) hastada kan transfüzyonu gereksinimi olduğu ve 1 (%2.2) hastada hidropnömotoraks geliştiği saptandı. Sonuç olarak, özellikle perkütan cerrahi deneyimi az olan ürologlar için, seçilmiş üst kaliks taşları olan hastalarda subkostal giriş ile %80 civarında başarı oranının, düşük komplikasyon oranları ile birlikte sağlanabileceğini düşünmekteyiz.
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  • 1
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  • Turkish

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