HIRURŠKO LEČENJE PEDIJATRIJSKE UROLITIJAZE
Sažetak
Uvod: Hirurško lečenje urolitijaze kod dece je dosta kompleksno i specifično zbog određenih anatomskih i funkcionalnih posebnosti dečijeg uzrasta. Metode hirurškog lečenja u ovom uzrastu su: ekstrakorporalna litotripsija (ESWL), intrakorporalna (endoskopska) litotripsija: pneumatska i laserska, perkutana nefrolitotripsija (PCNL) i otvorena hirurgija. Cilj rada je evaluacija efekata ureterorenoskopije i endoskopske litotripsije kod dece, kao metode minimalno invazivnog hirurškog lečenja.
Materijal i metode: Retrospektivna studija sprovedena je u Institutu za zdravstvenu zaštitu majke i deteta Srbije „Dr Vukan Čupić“ u Beogradu u periodu od 2010. do 2020. godine. U studiju je bilo uključeno 112 bolesnika (50 dečaka i 62 devojčice) uzrasta od 1-18 godina sa urolitijazom, lečenih metodom endoskopske (laserske ili pneumatske) litotripsije.
Rezultati: Posle jedne ureterorenoskopije kalkulus je uspešno dezintegrisan kod 87 (78%) pacijenata: u pijelonu kod 22 (79%), u čašicama gornjeg pola bubrega kod svih 14 (100%), u čašicama donjeg pola bubrega kod 10 (50%), u proksimalnom segmentu uretera kod 10 (83%), u distalnom segmentu uretera kod 27 (79%), u mokraćnoj bešici kod 4 (100%) bolesnika. Kod 19 (17%) pacijenata bila je potrebna i druga intervencija, te je ukupna uspešnost procedure postignuta: u pijelonu kod 28 (100%), u čašicama gornjeg pola kod 14 (100%), u čašicama donjeg pola 14 (70%), u proksimalnom segmentu uretera kod 12 (100%), u distalnom segmentu uretera kod 34 (100%); i u mokraćnoj bešici kod 4 (100%) pacijenata.
Zaključak: Primarni način lečenja pedijatrijske urolitijaze je ureterorenoskopija u kombinaciji sa pneumatskom ili laserskom litotripsijom. Uspešno se primenjuje u svim segmentima urinarnog trakta, s tim što je njena primena donekle limitirana u čašicama donjeg pola bubrega zbog anatomskih okolnosti i mehaničkih ograničenja instrumenata.
Ključne reči: urolitijaza, deca, litotripsija, ureterorenoskopija, efikasnost
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