Üriner Sistem Taş Hastalığı Tedavisi: Perkütan Nefrolitotomi, Mini PNL
Özet
Perkütan nefrolitotomi (PNL), büyük ve kompleks böbrek taşlarının tedavisinde günümüzde altın standart yöntemlerden biridir. İlk olarak 1976 yılında tanımlanan bu yöntem, zaman içinde teknolojik gelişmelerle birlikte önemli değişim göstermiştir. Başlangıçta geniş çaplı enstrümanlarla ve prone pozisyonda uygulanan PNL, günümüzde mini-PNL ve supin pozisyon gibi daha minimal invaziv yaklaşımlarla çeşitlenmiştir. Mini-PNL, genellikle 20 Fr’nin altında kılıf kullanılarak yapılan işlemleri tanımlar ve daha az cerrahi travma, düşük komplikasyon oranı ve daha kısa hastanede yatış süresi sağlamasıyla öne çıkar. Ayrıca pediatrik ve yüksek riskli hasta gruplarında tercih edilebilecek güvenli bir yöntemdir. Cerrahi teknik açısından PNL, retrograd üreter kateterizasyonu, perkütan giriş ve taş fragmantasyonu basamaklarını içerir. Günümüzde lazer litotripsi, vakumlu akses kılıfları ve tüpsüz teknikler sayesinde hasta konforu ve taşsızlık oranları daha da artırılmıştır. Literatürde yapılan çalışmalar, mini-PNL’nin standart PNL ile benzer taşsızlık oranları sunduğunu ancak daha düşük morbidite sağladığını göstermektedir. Sonuç olarak, PNL’nin evrimi, ürolojide hasta güvenliğini ve yaşam kalitesini önceleyen, etkinliği yüksek cerrahi seçenekler sunmaktadır.
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