Açık parsiyel nefrektomide hemostatik ajan olarak kullanılan oksitlenmiş selüloz desteğin (Surgicel®) postoperatif bilgisayarlı tomografi görünümleri

Yıl 2020, Cilt: 12 Sayı: 2, 114 - 121, 23.07.2020

Bahadır Topuz , Sercan Yılmaz , Serdar Yalçın , Sanan Asgarlı , Engin Kaya , Murat Zor , Mesut Gürdal , Selahattin Bedir

Öz

Amaç: Kan transfüzyonu gerektiren hemoraji, parsiyel nefrektomi için en korkulan komplikasyonlardandır ve sıklığı %5 civarındadır. Böbrek parankimindeki kanama kontrolü amacıyla çeşitli hemostatik ajanlar geliştirilmiştir. Kliniğimizde hemostatik ajan olarak yuvarlanmış oksitlenmiş selüloz destek (Surgicel®) kullanmaktayız. Bu çalışmanın amacı, böbrekte kitle nedeniyle açık PN uygulanan ve intraoperatif Surgicel® kullanılan hastaların klinik verilerini ve postoperatif bilgisayarlı tomografi görüntülerindeki değişiklikleri anlatmaktır.

Gereç ve Yöntemler: Kliniğimizde Ocak 2016 - Aralık 2019 yılları arasında renal kitle nedeniyle açık parsiyel nefretkomi uygulanan 41 hastanın kayıtları retrospektif incelendi. Preoperatif dinamik kontrastlı abdominal bilgisayarlı tomografiye göre tümörün tarafı, boyutu, lokalizasyonu, görünümü ve toplayıcı sistem ile ilişkisi incelendi. Rezidüel renal parankimal değişikliği değerlendirmek üzere postoperatif 3. ayda dinamik kontrastlı abdominal bilgisayarlı tomografi uygulandı.

Bulgular: Hastaların ortalama yaşı 54.9±11.44 (31-77) idi. Hastaların 19’u (%46.35) kadın, 22’si (%53.65) erkek idi. Tümör en sık böbrek alt polünde (n:16; %39.02) yerleşmekteydi ve malign kitlelerin tamamı (n:33; %80.49) renal hücreli karsinom olarak bildirildi. Postoperatif toplam 33 hastaya bilgisayarlı tomografi uygulandı. En sık görüntü karakteristiği parankimal defekt (n:14; %42.42) iken, ikinci sıklıkta yoğun içerikli kist (n:9; %27.27), üçüncü sıklıkta kronik koleksiyon (n:3; %9.09) idi. Hastaların tamamında intraoperatif Surgicel® kullanıldı ancak sadece 3 (%9.09) hastada ameliyat materyali saptandı.

Sonuç: Parsiyel nefrektomi sonrası kullanılan hemostatik ajanların postoperatif oluşturduğu değişikliklerin ve buna bağlı gelişen görüntü karakteristiklerinin bilinmesi önemlidir. Çünkü bu değişiklikler, postoperatif tümör nüksü veya apse gibi sonuçlarla karışabilmektedir. 

Anahtar Kelimeler

Hemostatik ajan, Oksitlenmiş selüloz destek (Surgicel®), Parsiyel nefrektomi

Postoperative computed tomography appearances of oxidized cellulose bolster (Surgicel®) used as hemostatic agent in open partial nephrectomy

Öz

Objectives: Hemorrhage requiring blood transfusion is one of the most feared complications for partial nephrectomy and its frequency is around 5%. Various hemostatic agents have been developed to control bleeding in the renal parenchyma. In our clinic, we use rolled oxidized cellulose bolster (Surgicel®) as a hemostatic agent. The aim of this study is to define the clinical data of patients and changes in postoperative computed tomography images who underwent open partial nephrectomy due to a mass in the kidney.
Material and Methods: The records of 41 patients who underwent open partial nephrectomy due to renal mass in our clinic between January 2016 and December 2019 were reviewed retrospectively. According to the preoperative dynamic contrast abdominal computed tomography, the side of the tumor, its size, localization, appearance, and its relationship with the collecting system were examined. Dynamic contrast abdominal computed tomography was performed to assess residual renal parenchymal change at the postoperative 3rd month.
Results: The mean age of the patients was 54.9±11.44 (31-77). Nineteen (46.35%) of the patients were female and 22 (53.65%) were male. The tumor was most frequently located in the lower pole (n:16; 39.02%) and all of the malignant masses (n:33; 80.49%) were renal cell carcinoma. Postoperative computed tomography was applied to a total of 33 patients. The most common image characteristic was the parenchymal defect (n:14; 42.42%), while the second most common was the dense cyst (n:9; 27.27%) and the third was the chronic collection (n:3; 9.09%). Intraoperative Surgicel® was used in all patients, but only 3 (9.09%) patients had surgical material.
Conclusion: It is important to know the postoperative changes of hemostatic agents used after partial nephrectomy and the associated image characteristics. Because these changes may be complicated with outcomes such as postoperative tumor recurrence or abscess.

Anahtar Kelimeler

Hemostatic agent, oxidized cellulose bolster, partial nephrectomy

Kaynakça

• Kisa E, Sahin H, Cakmak O, et al. Magnetic resonance imaging characteristics and changes in hemostatic agents after partial nephrectomy. Int Urol Nephrol 2019;51:917-925. https://doi.org/10.1007/s11255-019-02141-1
• Carrion DM, Y Gregorio SA, Rivas JG, et al. The role of hemostatic agents in preventing complications in laparoscopic partial nephrectomy. Cent European J Urol 2017;70:362-367. https://doi.org/10.5173/ceju.2017.1432
• Gieraerts C, Vanhoutte E, Laenen A, et al. Safety and efficacy of embolotherapy for severe hemorrhage after partial nephrectomy. Acta Radiol 2020. https://doi.org/10.1177/0284185120907253
• Lang H, Mouracade P, Gimel P, et al. National prospective study on the use of local haemostatic agents during partial nephrectomy. BJU Int 2014;113:E56-61. https://doi.org/10.1111/bju.12397
• Dabestani S, Marconi L, Kuusk T, Bex A. Follow-up after curative treatment of localised renal cell carcinoma. World J Urol 2018;36:1953-1959. https://doi.org/10.1007/s00345-018-2338-z
• Lee MS, Oh YT, Han WK, et al. CT findings after nephron-sparing surgery of renal tumors. AJR Am J Roentgenol 2007;189:W264-W271. https://doi.org/10.2214/AJR.07.2542
• Thorstenson A, Bergman M, Scherman-Plogell AH, et al. Tumour characteristics and surgical treatment of renal cell carcinoma in Sweden 2005-2010: a population-based study from the national Swedish kidney cancer register. Scand J Urol 2014;48:231-238. https://doi.org/10.3109/21681805.2013.864698
• Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO classification of tumours of the urinary system and male genital organs-part a: renal, penile, and testicular tumours. Eur Urol 2016;70:93-105. https://doi.org/10.1016/j.eururo.2016.02.029
• Capitanio U, Cloutier V, Zini L, et al. A critical assessment of the prognostic value of clear cell, papillary and chromophobe histological subtypes in renal cell carcinoma: a population-based study. BJU Int 2009;103:1496-1500. https://doi.org/10.1111/j.1464-410X.2008.08259.x
• Janssen MWW, Linxweiler J, Terwey S, et al. Survival outcomes in patients with large (≥7cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: results of a multicenter cohort with long-term follow-up. PLoS One 2018;13:e0196427. https://doi.org/10.1371/journal.pone.0196427
• Kim TS, Park JG, Kang H, et al. Computed tomography imaging features and changes in hemostatic agents after laparoscopic partial nephrectomy. J Endourol 2016;30:950-957. https://doi.org/10.1089/end.2016.0263
• Pai D, Willatt JM, Korobkin M, et al. CT appearances following laparoscopic partial nephrectomy for renal cell carcinoma using a rolled cellulose bolster. Cancer Imaging 2010;10:161-168. https://doi.org/10.1102/1470-7330.2010.0023
• Maurice MJ, Ramirez D, Kara Ö, et al. Omission of hemostatic agents during robotic partial nephrectomy does not ıncrease postoperative bleeding risk. J Endourol 2016;30:877-883. https://doi.org/10.1089/end.2016.0192