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Die Verwendung von Gelatine-Thrombin-Matrix zum Verschluss des Arbeitskanals bei der nephrostomielosen minimal-invasiven perkutanen Nephrolitholapaxie

Use of a gelatine-thrombin matrix for closure of the access tract without a nephrostomy tube in minimally invasive percutaneous nephrolitholapaxy

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Zusammenfassung

Hintergrund

Mit der Etablierung der miniaturisierten perkutanen Nephrolitholapaxie (miniPCNL) wird das Indikationsspektrum der perkutanen Steinsanierung auch auf kleinere Konkremente erweitert. Um Urinparavasate und Blutungen zu vermeiden, wurde bisher am Ende des Eingriffs ein Nephrostomiekatheter eingelegt. Statt dessen kann der Zugangstrakt in das Hohlraumsystem nach dem Eingriff mit einer Gelatine-Thrombin-Matrix versiegelt werden. In der vorliegenden Arbeit soll die nephrostomielose miniPCNL und die herkömmliche Methode mit Nephrostomieanlage verglichen werden.

Material und Methoden

Nach miniPCNL wurden 20 konsekutive Patienten mit Nephrostomieeinlage mit 20 konsekutiven Patienten mit Nephrostomie des Zugangskanals mit Gelatine-Thrombin-Matrix retrospektiv verglichen. Klinische Daten wie Hb-Abfall, Schmerzmittelverbrauch, Komplikationen und Hospitalisierungszeit wurden verglichen.

Ergebnisse

In keiner der beiden Gruppen gab es schwere perioperative Komplikationen. Keinem Patienten musste Blut transfundiert werden. Der totale Schmerzmittelverbrauch in beiden Gruppen unterschied sich statistisch nicht signifikant, die Patienten mit Direktverschluss benötigten jedoch über einen längeren Zeitraum Analgetika. Die Hospitalisierungszeit unterschied sich nicht signifikant (3,2 bei Direktverschluss vs. 3,4 Tage bei Nephrostomieeinlage). Die primäre Steinfreiheitsrate war in der Gruppe mit Direktverschluss höher (95% vs. 85%).

Schlussfolgerung

Der Verschluss des Zugangsweges nach erfolgter miniPCNL ist sicher, effektiv und kann Schmerzen und Dyskomfort der Patienten gegenüber der temporären Einlage einer Nierenfistel reduzieren.

Abstract

Background

The spectrum of percutaneous stone treatment was significantly widened following the introduction of the miniaturized percutaneous nephrolitholapaxy. At the end of the procedure usually a nephrostomy tube was placed to avoid urine paravasation and prolonged bleeding. In this work the tube-less mini-PCNL with direct closure of the access tract was compared to traditional mini-PCNL with placement of the nephrostomy tube.

Patients and methods

Twenty consecutive patients undergoing mini-PCNL with placement of a nephrostomy tube at the end of the procedure were compared to 20 consecutive patients with direct closure of the access tracts following percutaneous stone removal. Clinical data like decrease in Hb, complications, need for analgesics and duration of hospital stay were compared.

Results

Both groups underwent the procedure without complications. There was no need for blood transfusions. The difference in total analgetic dose was not statistically significant; however, patients in the nephrostomy group needed analgetics for a longer period of time. There was no difference in duration of hospital stay (3.2 days in the tube-less group versus 3.4 days in the nephrostomy group). The primary stone-free rate was higher in the group with direct closure of the access tract (95 versus 85%).

Conclusions

Closure of the percutaneous access following mini-PCNL with a gelatine-thrombin-haemostatic sealant is a safe alternative to the commonly used nephrostomy tube and can help to reduce postoperative pain and patient discomfort.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung/en hin: Dr. U. Nagele und Dr. D. Schilling üben Referenztätigkeiten für die Fa. Storz und die Fa. Baxter aus. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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Schilling, D., Winter, B., Merseburger, A. et al. Die Verwendung von Gelatine-Thrombin-Matrix zum Verschluss des Arbeitskanals bei der nephrostomielosen minimal-invasiven perkutanen Nephrolitholapaxie. Urologe 47, 601–607 (2008). https://doi.org/10.1007/s00120-008-1673-x

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