Üreteropelvik bileşke darlığı nedeniyle transperitoneal laparoskopik pyeloplasti uygulanan hastaların sonuçlarının değerlendirilmesi
Başlık çevirisi mevcut değil.
- Tez No: 406759
- Danışmanlar: PROF. DR. FAİKA GÜLCE HAKGÜDER
- Tez Türü: Tıpta Uzmanlık
- Konular: Çocuk Cerrahisi, Pediatric Surgery
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2015
- Dil: Türkçe
- Üniversite: Dokuz Eylül Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Çocuk Cerrahisi Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 61
Özet
Giriş ve Amaç: Transperitoneal laparoskopik pyeloplasti (TLP), üreteropelvik bileşke darlığı (ÜPBD) tedavisinde artan bir sıklıkta tercih edilmektedir. Ancak teknik imkanların kısıtlılığı ve deneyim eksikliği yaygın uygulamayı sınırlamaktadır. Bu çalışmada ÜPBD tedavisinde uyguladığımız TLP yönteminin tedavi etkinliği üzerine sonuçlarımızın değerlendirilmesi amaçlanmıştır. Hastalar ve Metod: Ekim 2005–Mart 2014 tarihleri arasında, ÜPBD nedeniyle TLP uygulanan hastalar yaş, cinsiyet, etkilenen taraf, cerrahi teknik, operasyon süresi, komplikasyonlar, hastanede kalış süresi, izlem süreleri açısından değerlendirildi. İstatiksel analiz için SPSS 15,0 programı kullanıldı. Gruplar arasındaki istatiksel farklılıklar Kruskal Wallis, Ki kare, Mann Whitney U ve Wilcoxon testleri kullanılarak değerlendirildi. İstatiksel olarak P
Özet (Çeviri)
Objective: Transperitoneal laparoscopic pyeloplasty (TLP) is an increasingly preferred treatment of ureteropelvic junction obstruction (UPJO). However, the limited availability of technical facilities and lack of experience will limit widespread application. In this study, we aimed to evaluate results of our TLP experiences in the treatment UPJO. Materials and Methods: Between October 2005- March 2014, patients who were treated with TLP method were evaluated. Patient characteristics including age, gender, affected side, surgical methods, operation time, discharge time, follow-up period and complication rate were reviewed. The statistical analyze was done with the SPSS 15.0 software using the Kruskal Wallis test, Wilcoxon testi, Mann-Whitney U test and Chi-Square test. A p-value less than 0,05 have been considered as significant statistically. Results: Total 39 UPJO (27 left, 12 right). were operated in 38 patient (24 males, 14 females) followed with UPJO diagnosis. The median age of patients were 105 months (9-192 months). While 10 patients were diagnosed with prenatal hydronephrosis, 28 had pain, hematuria, and signs of urinary tract infection. Two patients who underwent open surgery with a diagnosis of UPJO were secondary cases. Six patients (% 15.7) with vascular compression, two patients (% 5.2) with double collecting system and one patient (% 2.6) with ectopic pelvic kidney abnormalities detected. Four patients (% 10.2) were treated via trans-mesocolic methods while the rest had their colon is mobilized. Interrupted suture technique was used in the first 16 patients and continuous suture technique was used in the last 23 patients. J-J catheter was inserted in all cases and the drain was not used. The average operative time was 144 ± 46 minutes (80-245 min). Mean operative time of cases who used interrupted suture technique was 187 minutes and was 115 minutes in those whose continuous suture technique. Due to tissue inflammation and fragility in a patient with preoperative nephrostomy catheter was treated with open surgery. In 5 patients (% 12.8) postoperative complications were observed. In one patient was seen extravasation after was pulled the J-J cateter and in another one of patient was seen falled into the bladder. Intestinal obstruction depend compression the bowel at place of port was seen in one patient and perirenal hematoma and subcutaneous emphysema was seen another one. Three cases (% 7.6) were diagnosed as recurrent stenosis, two of which (% 5.1) underwent open pyeloplasty. One out of the two underwent tertiary TLP. This patients underwent balloon dilation. Due to a lack of response, open pyeloplasty was applied. In the third case (% 2.6) were the response to balloon dilatation. The mean duration of hospitalization 3.05 ± 1.6 days (2-11 days), mean post-operative follow-up period was 22.4 ± 14 months (6-51 months). Conclusion: TLP is lower complications rates, better cosmetic results and advantages due to in cases with anatomic variations may prefer as a first option for the treatment of the UPJO. The anastomosis with continuous suture technique in the operative time is shorter.
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