Üriner Sistem Taş Hastalığı Cerrahi Tedavisinde Minimal İnvaziv Yaklaşımlar II: Perkütan Taş Cerrahisi
Özet
Üriner sistem taş hastalığının cerrahi tedavisinde geleneksel açık yaklaşımlar, yerini önemli ölçüde perkütan nefrolitotomi (PNL) gibi minimal invaziv yöntemlere bırakmıştır. PNL, özellikle 20 mm’den büyük böbrek taşlarında ve diğer tedavilerin başarısız olduğu durumlarda ilk seçenek haline gelmiş, yetişkin ve pediatrik hastalarda standart bir uygulama olmuştur. Cerrahi operasyon temel olarak üretere kateter yerleştirilmesi, böbreğe perkütan giriş yapılarak trakt oluşturulması ve taşların fragmante edilerek dışarı çıkarılması adımlarından oluşur. Uygulama esnasında cerrahın deneyimine ve hastanın anatomik durumuna göre pron veya supin pozisyonları tercih edilmektedir. Gelişen teknoloji ve cerrahi tecrübenin artmasıyla birlikte, postoperatif ağrıyı azaltmak ve hastanede kalış süresini kısaltmak amacıyla nefrostomi tüpü kullanılmayan tüpsüz (tubeless) veya total tüpsüz yaklaşımlar geliştirilmiştir. Ayrıca, çocuk hastalardaki komplikasyon riskini azaltmak ve daha az invaziv bir süreç sağlamak amacıyla trakt çapının küçültüldüğü mini-PNL, ultramini-PNL ve dilatasyon gerektirmeyen mikro-PNL gibi mikrodüzeydeki yöntemler de yaygınlık kazanmıştır. Tüm bu avantajlarına rağmen PNL operasyonları; kanama, toplayıcı sistem perforasyonu, postoperatif ateş, sepsis ve plevra ya da kolon gibi komşu organ yaralanmaları dahil olmak üzere %10-25 oranında ciddi komplikasyon riskleri barındırmaktadır.
In the surgical treatment of urinary system stone disease, traditional open approaches have largely been replaced by minimally invasive methods such as percutaneous nephrolithotomy (PCNL). PCNL has become the first-choice treatment, especially for kidney stones larger than 20 mm and in cases where other treatments fail, serving as a standard intervention in both adult and pediatric patients. The operation basically consists of placing a catheter into the ureter, gaining percutaneous access to the kidney to create a tract, and fragmenting and removing the stones. During the procedure, prone or supine positions are preferred depending on the surgeon's experience and the patient's anatomy. With technological advancements and increasing surgical experience, tubeless or total tubeless approaches, which omit the use of a nephrostomy tube, have been developed to reduce postoperative pain and shorten hospital stays. Furthermore, to minimize complication risks in pediatric patients and ensure a less invasive process, minimized tract methods like mini-PCNL, ultramini-PCNL, and micro-PCNL, which requires no dilation, have gained popularity. Despite its advantages, PCNL procedures carry a serious complication rate of 10-25%, including bleeding, collecting system perforation, postoperative fever, sepsis, and adjacent organ injuries such as the pleura or colon.
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