Nýrnasteintökur um húð

Abstract

In the years 1985 to 1993, 92 patients, 61 men and 31 women, went to PCNL for stone removal at the Urology Department in the Reykjavik City Hospital, total 112 procedures. It was almost every patient who needed surgery for stone in the upper urinary tract. Most of the patients went home from the hospital in good health two or three days after the operation. Operation on the left kidney was more common (59%) than on the right one (41%). The stone size was 4-40 mm in diameter, mean 12 mm. In 70% of the operations there was one stone, but in 10% there were four stones or more. The procedure was done in two stages in 64% but in one stage in 36%. Stones in the upper ureter (26%) were first manipulated up into the renal pelvis. In 82% of the operations we did not have to disintegrate the stones but in 18% we used ultrasound or electrohydrolic-waves to do so. 87% of the patients needed only one operation. The results were that 87.5% of the patients were stonefree or had stonerests 4 mm or less after one procedure. Thirteen patients were taken more than once to PCNL, five of them got rid of their stones after repeated operations. Thus 90.2% of the 92 patients were managed successfully, that is stone-free or had stonerests smaller than 4 mm. No serious complications were noted. The most common complication was leakage of contrast media as a sign of perforation of the renal pelvis in 29 procedures. It always held without further complication within a few days with a nephrostomy.

Gerð er örstutt grein fyrir sögulegri þróun aðgerða við nýrnasteinum allt til okkar daga. Skoðaðir voru allir sjúklingar sem gengust undir steintöku um húð (percutaneous nephrolithotomy, PCNL) á Borgarspítalanum á árunum 1985-1993. Aðferðinni er lýst og rætt um notagildi hliðstæðrar tækni viö aðra sjúkdóma. Níutíu og tveir sjúklingar fóru í samtals 112 nýrnasteinatökur um húð. Árangur varð sá að í 87,5% tilvika losnuðu sjúklingar við steina eða höfðu steinleifar minni en 4 mm eftir eina aðgerð. Eftir endurteknar aðgerðir losnuðu 90,2% sjúklinganna við steina eða steinleifar voru 4 mm eða minni og er það svipaður árangur og í sambærilegum erlendum rannsóknum og telst viðunandi. Engir alvarlegir fylgikvillar komu fram og enginn sjúklinganna þurfti að fara í opna aðgerð vegna fylgikvilla. Sjúklingarnir þoldu aðgerðina vel og útskrifuðust venjulega tveimur til þremur dögum eftir aðgerð, vinnufærir.