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14
II. ХИРУРГИЯ
УДК 616-089.1
COMPARATIVE ANALYSIS OF THE EFFECTIVENESS OF MINIMALLY INVASIVE SURGICAL INTERVENTIONS FOR KIDNEY STONES
ABOUT THE ÄUTHORS
Mami Darkhan Erlanuly -
a resident mentor at the Department of Urology of the NJSC "National Medical University named after S.D. Asfendiyarov", doctor in Department of urolithiasis and En-dourology, JSC "Scientific Center of Urology named after B.U. Dzharbusynov". Darhan.
[email protected], +77017107374
Alchinbaev Mirzakarim Karimovich -
Head of the Department of Urology, NJSC "National Medical University named after S.D. Asfendiyarov", Academician of the National Academy of Sciences of the Republic of Kazakhstan, Doctor of Medicine, Professor.
Sengirbaev Daurenbek Isakovich -
Professor of the Department of Urology of the NJSC "National Medical University named after S.D. Asfendiyarov", Ph.D.
Malikh Mohammad Aref -
Head of the Department of urolithiasis and Endourology of the JSC "Scientific Center of Urology named after B.U. Dzharbusynov", MD, professor.
Keywords
RPT, PCNL, nephrolithiasis
Mami D.E.12, Alchinbaev M.K.1, Sengirbaev D.I.1, Malikh M.A.2
1NJSC "National Medical University named after S.D. Asfendiyarov" JSC "Scientific Center of Urology named after B.U. Dzharbusynov", urolithiasis and Endourology Department, Almaty, Kazakhstan
Abstract
Urolithiasis is an urgent worldwide public health problem, as it remains one of the most common diseases. Therefore, the study of factors that increase the effectiveness and safety of treatment of patients with nephrolithiasis is an important task of urology. This article provides a comparative analysis of the effectiveness of minimally invasive methods, such as retrograde pyelolithotripsy (RPL) and percutaneous nephro-lithotripsy (PCNL) for nephrolithiasis. Purpose of the study. Conduct a comparative assessment of the effectiveness of minimally invasive treatment for kidney stones. Materials and methods. In the study, 109 patients with kidney stones who were hospitalized at the Scientific Center of Urology from 2017 to 2018. Retrograde pyelolithotripsy (RPT) was performed in 66 (60.5%) patients. Percutaneous nephrolithotripsy (PCNL) in 43 (39.4%) patients. Of these, 54 (49.5%) are men and 55 (50.5%) are women. Contlution: A comparative analysis of the results of treatment of patients with kidney stones showed that RPT is not inferior to PCNL in its effectiveness. Moreover, the percentage of intraoperative and postoperative complications is higher with PCNL. The effectiveness of PCNL immediately after surgery was 76.5%, RPT - 78.8%. Efficiency after 1 month was 82.8% and 88.1%, respectively. After PCNL, a significant decrease in glomerular filtration rate is determined, which is not observed after RPT. Improving the surgical treatment of urolithiasis will improve the quality of life of the population suffering from urolithiasis, reduce the incidence and disability of the population, reduce the length of hospital stay and rehabilitation.
АВТОРЛАР ТУРАЛЫ
Мэми Дархан Ерланупы - наставник резидентов на кафедре урологии НАО«Национального медицинского университета, им. С.Д. Асфендиярова», врач отделения МКБ и эндоурологии АО «Научного центра урологии им. Б.У. Джарбусынова». [email protected], +77017107374
Алчинбаев Мирзакарим Каримович
- заведующий кафедрой урологии НАО«Национального медицинского университета, им. С.Д. Асфендиярова», Академик НАН РК, д.м.н., профессор.
Сенгирбаев Дауренбек Исакович
- профессор кафедры урологии НАО«Национального медицинского университета, им. С.Д. Асфендиярова», к.м.н.
Малих Мохаммад Ареф - заведующий отделением МКБ и эндоурологии АО «Научного центра урологии им. Б.У. Джарбусынова», д.м.н., профессор.
Тужн сездер
РПЛ, ПНЛТ, нефролитиаз
Буйрек тастары кезшде емдеудщ мш1 инвазивт эдютершщ ттмдштне салыстырмалы талдау журпзу
Мэми Д.Е.1,2, Алчинбаев М.К.1, Сенгирбаев Д.И.1, Малих М.А.2
1НАО «Национальный медицинский университет, им. С.Д. Асфендиярова» 2АО «Научный центр урологии им. Б.У. Джарбусынова», кафедра урологии, отделении МКБ и эндоурологии, Алматы, Казахстан
Ацдатпа
Несеп-тас ауруы элемдеп денсаулык сактаудыщ езекл мэселеа болып табылады, ейткен ещ кеп тарашан аурулардьц ^ болып табылады. Сондыктан нефролитиазы бар наукдстарды емдеудщ тшмдшю мен кауЫздюн арт-тыратын факторларды зерттеу урологияныщ мащызды мндет болып табылады. Бул макалада нефролитиаз кезщеп ретроградты пиелолитотрипсия (РПЛ) жэне перкутанды нефролитотрипсия (ПНЛТ) сиякты кш инвазивт эдстер тшмдшШц салыстырмалы талдауы келщлген. Зерттеудщ мацсаты. БYЙрек тастары кезнде емдеудщ кш инвазивт эдютерЩ тшмдшюне салыстырмалы баталаужурпзу. Материалдар мен адстер. Зерттеу барысында бiз бYЙректастары бар 109 наукасты iрiктеп алдык, олар 2017-2018жылдар аралыгында Урология €ылыми орталыгында жаткызылды. Оныц шнде 54 (49,5%) ерлер жэне 55 (50,5%) эйелдер бошн. Цорытынды: бYЙрек тастары бар пациенттердi ем-деу нэтижелерне журпзшген салыстырмалы талдау ретроградты пиелолитотрипсия (РПЛ) езМщ тшмдшю бойынша перкутанды пиелолитотрипсиядан (ПНЛТ) кем туспейшн керсет. Ота кезщеп жэне отадан кешнп аскынулардыщ пайызы ПНЛТ эдiсi кезнде РПЛ эдсне каршнда жо€ары. ПНЛТ тшмдшю отадан кеШн брден 76,5% - ды, РПЛ-78,8% - ды курады. 1 айдан кейн тиiмдiлiк тШснше 82,8% жэне 88,1% курады. ПНЛТ отасынан кейн шумактык сYзу жылдамдышныщ айтарлыктай темендеуi аныкталады, бул РПЛ эдiсiнде байкалмайды. Хирургиялык емдеудi жаксарту несеп-тас аурумен (НТА) ауыратын халыктыщ емiр сYPУ сапасын жаксартады, халыктыщ аурушандыгы мен мYгедектiлiпн азайтады, ауруханада болу жэне ощалту узактышн ыкартады.
Сравнительный анализ эффективности малоинвазивных оперативных вмешательств при камнях почек
Мами Д.Е.12, Алчинбаев М.К.1, Сенгирбаев Д.И.1, Малих М.А.2
1НАО «Национальный медицинский университет, им. С.Д. Асфендиярова» 2АО «Научный центр урологии им. Б.У. Джарбусынова», кафедра урологии, отделении МКБ и эндоурологии, Алматы, Казахстан
Аннотация
Мочекаменная болезнь является одной из актуальных проблем медицинской отрасли во всем мире, так как остается одним из самых распространенных заболеваний. Поэтому исследование факторов, повышающих эффективность и безопасность лечения пациентов с нефролитиазом, является важной задачей урологии. В этой статье приведен сравнительной анализ эффективности малоинвазивных методов, как ретроградная пиелоли-тотрипсия (РПЛ) и перкутанная нефролитотрипсия (ПНЛТ) при нефролитиазе. Цель исследования. Провести сравнительную оценку эффективности малоинвазивных методов лечения при камнях почек. Материалы и методы. В работе проведены исследования 109 пациентам с конкрементами в почках, которые были госпитализированы в Научный центр урологии с 2017 по 2018 год. Ретроградная пиелолитотрипсия (РПЛ) была выполнена 66 (60,5%) пациентам. Перкутанная нефролитотрипсия (ПНЛТ) 43 (39,4%) пациентам. Из них 54 (49,5%) мужчин и 55 (50,5%) женщин. Выводы: Проведенный сравнительный анализ результатов лечения пациентов с конкрементами почек показал, что РПЛ по своей эффективности не уступает ПНЛТ. При этом процент интраоперационных и послеоперационных осложнений выше при ПНЛТ. Эффективность ПНЛТ сразу после операции составила 76,5%, РПЛ - 78,8%. Эффективность через 1 месяц составила 82,8% и 88,1% соответственно. После ПНЛТ определяется существенное снижение скорости клубочковой фильтрации, что не наблюдается после проведении РПЛ. Совершенствование хирургического лечения МКБ улучшит качество жизни населения, страдающего МКБ, снижение заболеваемости и инвалидизации населения, сокращает сроки пребывания в стационаре и реабилитации.
Introduction
Urolithiasis remains one of the most common urological diseases. The level of morbidity and disability among the population of the Republic of Kazakhstan is increasing every year, and most often among people of working age - 20 - 50 years. Patients with urolithiasis constitute for 30 - 40% of the total contingent of the urological hospital. The annual increase in the incidence of urolithiasis is 3-6%. In the period from 2010 to 2016, this indicator in Kazakhstan increased from 60.1 to 73.4 cases per 100 thousand people. The dynamics of the incidence of urolithiasis in the republic as a whole in 2016 in comparison with 2014. increased by 7.9%, and in relation to 2015 an increase of 2.7% was noted. Noticeable increase in incidence in 2016 in comparison with 2015, it was revealed in the city of Nur-Sultan - from 1204 cases to 2230. A decrease in the indicator was noted in Atyrau and Aktobe regions. The incidence of urolithiasis in 2016 per 100 thousand people in the republic as a whole was 76.6 (in 2016 - 75.5 in 2015 - 75.5, in 2014 - 713.4), with the highest indicators (higher than the republican one), as in 2014, were noted in the Zhambyl (211.7) region and the city of Nur-Sultan (287.1). The lowest rates were found in West Kazakhstan (13.1), Karaganda (44.9), Almaty (44.5) regions. [1]. In the Russian Federation in 2012, the incidence was 550.5 people per 100 thousand people, and its growth over the period from 2002 to 2012 exceeded 25%. In 2017, the incidence of urolithiasis was 177
people per 100 thousand population. In 2017, 207, 447 adult patients with an urolithiasis diagnosed for the first time in their life were registered in the Russian Federation, and the increase in incidence over the past 10 years exceeded 25% [2-3]. In the USA, nephrolithiasis is one of the main causes of urinary tract morbidity. The prevalence of this disease has increased over the past 20 years from 3.8% to 5.2% [4]. The annual incidence of urolithiasis in the world is 0.5-5.5%, and in some countries and areas endemic for the urolithiasis - 13-20% [5-6]. In recent decades, the focus is on the development and widespread introduction of contact lithotripsy and other modern high-tech treatment methods. At the same time, publications on diagnostic and treatment methods for urolithiasis are estimated in the thousands, while the prevalence of urolithiasis, the changing age composition of patients and gender distribution, the structure of urinary stones, exogenous and endogenous risk factors for the disease are rarely discussed in print [7-8].
The aim: Conduct a comparative analysis of the effectiveness of minimally invasive treatment for kidney stones.
In the study, 109 patients with kidney stones who were studied and hospitalized at the Scientific Center of Urology from 2017 to 2018. Retrograde pyelolithotripsy (RPT) was performed in 66 (60.5%) patients. Percutaneous nephrolithotripsy (PCNL) in 43 (39.4%) patients. Of these, 54 (49.5%) are men and 55 (50.5%) are women.
ОБ АВТОРАХ
Мэми Дархан Ерланулы — наставник резидентов на кафедре урологии НАО«Национального медицинского университета, им. С.Д. Асфендиярова», врач отделения МКБ и эндоурологии АО «Научного центра урологии им. Б.У. Джарбусынова». [email protected], +77017107374
Алчинбаев Мирзакарим Каримович
- заведующий кафедрой урологии НАО«Национального медицинского университета, им. С.Д. Асфендиярова», АкадемикНАН РК, д.м.н., профессор.
Сенгирбаев Дауренбек Исакович
- профессор кафедры урологии НАО«Национального медицинского университета, им. С.Д. Асфендиярова», к.м.н.
Малих Мохаммад Ареф — заведующий отделением МКБ и эндоурологии АО «Научного центра урологии им. Б.У. Джарбусынова», д.м.н., профессор.
Ключевые слова
РПЛ, ПНЛТ, нефролитиаз
BULLETIN OF SURGERY IN KAZAKHSTAN № 2-2020
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Table 1.
Indicators of patients after the RPT and PCNL.
RPT PCNL
Indicators Amount
Amount of patients 66 43
Male 25 (37,9%) 29 (67,4%)
Female 41 (62,1%) 14 (32,6%)
The average size of the calculus 2,1i1,5 см 3i1,6 см
The average density of calculus 1 644,2i212 HU
Diabetes 7 (63,6%) 4 (36,4%)
Arterial hypertension 21 (58,3%) 15 (41,7%)
Results
Retrograde pyelolithotripsy (RPT) was performed with single calculi of the pelvis. The main conditions for the RPT were the lack of expansion of the pyelocaliceal system, the thickness of the parenchyma is more than 1.7 cm, i.e. conditions that impede PCNL; anatomical and physiological structural features of the pyelocaliceal system, which complicate other interventions (intrarenal pelvis, narrow isthmus of the calyx). No intraoperative complications were observed. In 7 patients (10.6%), exacerbation of calculus pyelonephritis and reflux was noted after the installation of a stent catheter.
During percutaneous nephrolithotripsy, 4 patients (9.3%) experienced intraoperative bleeding, which required the separation of the PCNL procedure into 2 stages. In one case (2.3%), a conversion was required with open surgery (pyelolithotomy). An exacerbation of pyelonephritis was observed in 5 patients (11.6%).
The effectiveness of the operation was evaluated by the degree of purification of the renal cavity system from calculi. The operation was considered effective with complete extraction of calculus or in the presence of residual fragments less than 4 mm in size, which reduces the length of hospital stay and rehabilitation.
The average size of the removed calculi with RPT was 2.1 ± 1.5 cm, with PCNL 3 ± 1.6 cm. 11 patients had diabetes mellitus in the stage of compensation, 36 patients had arterial hypertension. The effectiveness of PCNL immediately after surgery was
References
1. Alchinbaev M.K., Mukhamedzhan I.T., Aubakirova A.T., Dakenova G.B. Analysis of the state of the uro-logical service of the Republic of Kazakhstan // Analytical review for 2016 (sixth edition) // Almaty, 2017 - 18-19 pp.
2. Apolikhin O. I., Sivkov A. V., Moskaleva N. G., Solnt-seva T. V., Komarova V. A. // Analysis of the urone-phrological morbidity and mortality in the Russian Federation over a ten-year period (2002-2012) according to official statistics // Experimental and clinical urology. 2014. N 2. C. 2-12.
3. Statistical compilation 2017 // Incidence of the adult population of Russia in 2017 // statistical materials, part III // Table 3.68. - p. 139. Moscow 2018.
4. Brener Z.Z. // Nephrolithiasis: evaluation and management // South Med. J. 2011. Vol. 104, suppl. 2. P. 133-139.
76.5%, RPT - 78.8%. The effectiveness of treatment after 1 month was 82.8% and 88.1%, respectively. No statistically significant differences were found.
When assessing the functional state of the kidneys after PCNL (glomerular filtration rate of GFR), it was found that the average level of GFR before surgery was 108.8 ± 20.5 ml / min. After 1 month, in the control study, the average GFR level was 74.4 ± 12.8 ml / min. After 6 months, control was performed on 32 patients. The average level of GFR was 86.6 ± 20.2 ml / min. Persistent renal failure was detected in 10 patients. The average level of GFR before RPT was 112.3 ± 17.6 ml / min. 6 months after surgery, the average level of GFR was 105.5 ± 18.1 ml / min.
Conclusion
A comparative analysis of the results of treatment of patients with kidney stones showed that RPT is not inferior to PCNL in its effectiveness. Moreover, the percentage of intraoperative and postoperative complications is higher with PCNL.
The effectiveness of PCNL immediately after surgery was 76.5%, RPT - 78.8%. Efficiency after 1 month was 82.8% and 88.1%, respectively.
After PCNL, a significant decrease in glomerular filtration rate is determined, which is not observed after RPT. Improving the surgical treatment of urolithiasis will improve the quality of life of the population suffering from urolithiasis, reduce the incidence and disability of the population, reduce the length of hospital stay and rehabilitation.
5. Fisang C., Anding R., Mbller S.C, Latz S., Laube N. // Urolithiasis an interdisciplinary diagnostic, therapeutic and secondary preventive challenge. // Dtsch Arztebl Int. 2015; 112 (6):83-91. doi: 10.3238/arz-tebl.2015.0083.
6. Knoll T. Epidemiology, Pathogenesis, and Pathophysiology of Urolithiasis. Eur Urol 2010;9:802-6. doi: 10.1016/j.eursup.2010.11.006.
7. Yanenko E.K., Merinov D.S., Konstantinova O.V., Epishov V.A., Kalinichenko D.N. // Current trends in epidemiology, diagnosis and treatment of uroli-thiasis. // Experimental and Clinical Urology 2012; 3: 19-24.
8. Davidov M.I., Dremin E.I., Nikonova O.E., Gushchina T.S. // Epidemiology of urolithiasis in the Perm region: results of a 30-year study // Experimental and Clinical Urology 2019; No. 3: pp. 4-10.
