RENTGENSIZ VA NAYCHASIZ MINI-PERKUTAN NEFROLITOTOMIYA: QANDAY AFZALLIKLARI BOR?
Keywords:
nefrolitiaz, mini-perkutan nefrolitotomiya (mini-PCNL), fluoroskopiyasiz mini-PCNL, nefrostomasiz (tubeless) texnikaAbstract
Nefrolitiaz butun dunyoda eng keng tarqalgan va qaytalanuvchi urologik kasalliklardan biri bo'lib qolmoqda. Fluoroskopiyasiz perkutan nefrolitotomiya (PCNL) bo'yicha birinchi tadqiqotlar chop etilganidan beri, ko'plab perkutan jarrohlar ushbu texnika tez orada keng qo'llanilishidan umid qilishgan. Fluoroskopiyasiz naychasiz mini-PCNL xavfsiz, samarali va amalga oshirish mumkin bo'lgan usul ekanligi isbotlangan. Material va usullar: Ushbu qiyosiy prospektiv tadqiqotga 2023-yil fevraldan 2025-yil dekabrgacha yuqori siydik yo'llari toshlari bo'lgan va mini-PCNL o'tkazilgan 100 nafar bemor kiritildi. Ellik bemorga fluoroskopiyasiz naychasiz mini-PCNL (1-guruh), qolgan 50 nafariga esa fluoroskopiya yordamida an'anaviy mini-PCNL (2-guruh) o'tkazildi. Fluoroskopiyasiz guruhda perkutan kirish Galdakao-modifikatsiyalangan supin Valdivia holatida ultratovush nazorati ostida amalga oshirildi. Toshdan xoli holat (SFR) to'liq tosh tozalanishi yoki klinik ahamiyatsiz, ≤3 mm qoldiq fragmentlar mavjudligi sifatida belgilandi. Oldindan nefrostomik trakti bo'lgan bemorlar tadqiqotga kiritilmadi. O'rtacha yosh 1-guruhda 36 (IQR 29,0; 42,8), 2-guruhda 41 (IQR 33,3; 48,8) ni tashkil etdi. O'rtacha tosh o'lchami 1-guruhda 24,5 (IQR 19,0; 30,8), 2-guruhda 31,5 (IQR 28; 35) ni tashkil etdi. Natijalar: O'rtacha operatsiya vaqti 1-guruhda 38,5 (IQR 35; 42), 2-guruhda 32,5 (IQR 30; 35) daqiqani tashkil etdi. Operatsiyadan keyingi 2-kunda gemoglobin darajasining pasayishi mos ravishda ikkala guruhda 2,7 (IQR 2,1; 3,2) va 2,3 (IQR 1,9; 2,9) ni tashkil etdi. Analgetiklarga bo'lgan ehtiyoj 1-guruhda pastroq bo'ldi (225,0 [IQR 150,0; 225,0] ga qarshi 237,5 [IQR 215,0; 268,8], p = 0,003). Statsionarda yotish muddati yoki kichik asoratlar bo'yicha sezilarli farqlar aniqlanmadi. Xulosalar: Fluoroskopiyasiz naychasiz mini-PCNL buyrak toshlarini davolashda xavfsiz va samarali texnika hisoblanadi. U bemor va jarrohlik jamoasi uchun radiatsiya ta'sirini butunlay yo'q qilgan holda, an'anaviy mini-PCNL bilan teng keladigan toshdan xoli bo'lish darajasi va xavfsizlik profilini ta'minlaydi
Downloads
References
1. Goodwin W, Casey W, Woolf W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc. 1955 Mar 12;157(11):891-4. doi:10.1001/jama.1955.02950280015005. PMID: 13233046.
2. Liu Q, Zhou L, Cai X, Jin T, Wang K (2017) Fluoroscopy versus ultrasound for image guidance during percutaneous nephrolithotomy: a systematic review and meta-analysis. Urolithiasis 45:481-487.
3. Usawachintachit M, Masic S, Allen IE, Li J, Chi T. Adopting Ultrasound Guidance for Prone Percutaneous Nephrolithotomy: Evaluating the Learning Curve for the Experienced Surgeon. J Endourol. 2016 Aug;30(8):856-63. doi: 10.1089/end.2016.0241. Epub 2016 Jun 13. PMID: 27150671; PMCID: PMC4964751.
4. Corrales M, Doizi S, Barghouthy Y, Kamkoum H, Somani B, Traxer O. Ultrasound or Fluoroscopy for Percutaneous Nephrolithotomy Access, Is There Really a Difference? A Review of Literature. J Endourol. 2021 Mar;35(3):241-248. doi: 10.1089/end.2020.0672. Epub 2020 Oct 8. PMID: 32762266.
5. Kyriazis I, Liatsikos E, Sopilidis O, Kallidonis P, Skolarikos A; European Section of Urotechnology (ESUT). European Section of Urotechnology educational video on fluoroscopic-guided puncture in percutaneous nephrolithotomy: all techniques step by step. BJU Int. 2017 Nov;120(5):739-741. doi: 10.1111/bju.13894. Epub 2017 May 21. PMID: 28437028.
6. Xiao B, Chen Y, Lin S, Zeng X, Liu Y, Xu Y, Huang H, Luo Z, Bai W, Li J. Evaluating the learning curve of total ultrasound guided percutaneous nephrolithotomy in complex renal stones using "30-degree triangulation" technique. World J Urol. 2025 May 16;43(1):312. doi: 10.1007/s00345-025-05674-6. PMID: 40377746.
7. Sh. T. Mukhtarov et al.: Choosing the Optimal Size for the Nephrostomy Tube after Standard Percutaneous Nephrolithotomy: A Randomized Trial. American Journal of Medicine and Medical Sciences 2023, 13(2): 165-169 DOI: 10.5923/j.ajmms.20231302.29.
8. Pabon-Ramos WM, Dariushnia SR, Walker TG, d'Othée BJ, Ganguli S, Midia M, Siddiqi N, Kalva SP, Nikolic B; Society of Interventional Radiology Standards of Practice Committee. Quality Improvement Guidelines for Percutaneous Nephrostomy. J Vasc Interv Radiol. 2016 Mar;27(3):410-4. doi: 10.1016/j.jvir.2015.11.045. Epub 2016 Jan 21. PMID: 26803576.
9. Desai M, Ridhorkar V, Patel S, Bapat S, Desai M. Pediatric percutaneous nephrolithotomy: assessing impact of technical innovations on safety and efficacy. J Endourol. 1999 Jun;13(5):359-64. doi: 10.1089/end.1999.13.359. PMID: 10446796.
10. Birowo P, Raharja PAR, Putra HWK, Rustandi R, Atmoko W, Rasyid N. X-ray-free ultrasound-guided versus fluoroscopy-guided percutaneous nephrolithotomy: a comparative study with historical control. Int Urol Nephrol. 2020 Dec;52(12):2253-2259. doi: 10.1007/s11255-020-02577-w. Epub 2020 Jul 24. PMID: 32710296; PMCID: PMC7655569.
11. Hosier GW, Hakam N, Hamouche F, Cortez X, Charondo L, Yang H, Chan C, Chang K, Unno R, Sui W, Bayne DB, Stoller ML, Chi T. Ultrasound-Only Percutaneous Nephrolithotomy Is Safe and Effective Compared to Fluoroscopy-Directed Percutaneous Nephrolithotomy. J Endourol. 2023 Jun;37(6):634-641. doi: 10.1089/end.2022.0761. Epub 2023 May 9. Erratum in: J Endourol. 2023 Aug;37(8):972. doi: 10.1089/end.2022.0761.correx. PMID: 37051696; PMCID: PMC10771882.
12. Musolino SV, DeFranco J, Schlueck R. The ALARA principle in the context of a radiological or nuclear emergency. Health Phys. 2008 Feb;94(2):109-11. doi: 10.1097/01.HP.0000285801.87304.3f. PMID: 18188044.
13. Usawachintachit M, Tzou DT, Washington SL 3rd, Hu W, Li J, Chi T. Ultrasound-Guided Renal Access and Tract Dilation. Videourology (New Rochelle). 2017 Feb 8;31(1):vid.2016.0046. doi: 10.1089/vid.2016.0046. PMID: 32292638; PMCID: PMC6964241.
