Tujuan Untuk mengetahui kejadian VTE pada pasien Indonesia yang menjalani bedah ortopedi mayor dan tidak menerima tromboprofi laksis. Metode Uji klinik terbuka pada pasien Indonesia yang menjalani bedah ortopedi mayor, dilakukan di 3 senter di Jakarta. Venografi bilateral dilakukan antara 5 dan 8 hari pasca bedah untuk menemukan VTE yang asimptomatik dan memastikan VTE yang simptomatik. Pasien dievaluasi hingga 1 bulan pasca bedah. Hasil Telah diteliti 17 pasien dengan median usia 69 tahun dan 76,5% di antaranya perempuan. Enam belas dari 17 pasien (94,1%) menjalani bedah fraktur panggul. Median waktu antara fraktur dengan tindakan adalah 23 hari (antara 2 sampai 197 hari), median lamanya tindakan bedah 90 menit (antara 60 sampai 255 menit), dan median lamanya imobilisasi 3 hari (antara 1 sampai 44 hari). Tiga belas dari 17 pasien menjalani venografi kontras untuk mendeteksi VTE yang asimtomatik. VTE ditemukan pada 9 dari 13 pasien (69,2%) saat akan keluar dari rumah sakit (RS). VTE yang simtomatik ditemukan pada 3 pasien (23,1%), semuanya dengan tanda-tanda klinis DVT dan tidak seorangpun dengan tanda klinis embolisme paru (PE). Pasien tersebut diobati dengan heparin berat molekul rendah, dilanjutkan dengan antikoagulan oral warfarin. Tidak ada kematian mendadak sampai pasien keluar dari RS. Tidak ada kasus VTE simtomatik baru sejak keluar dari RS sampai 1 bulan kemudian. Tidak ditemukan kematian mendadak, komplikasi pendarahan, ataupun perawatan ulang di RS dalam studi ini.
Background: Staghorn stones are mostly treated by percutaneous nephrolithotomy (PCNL), either with an upper-pole (UP) or non-upper (lower- or middle-) pole (NP) approach. NP access has a lower risk of bleeding and thoracic complications but may not be sufficient for complete stone clearance. UP access is advocated as the preferred approach, because of direct access to the collecting system. However, it is associated with a higher complications rate, including pneumothorax and hydrothorax, and a higher risk of bleeding. This meta-analysis aimed to describe the outcomes and safety of PCNL for staghorn stones using UP and NP approaches. Methods: A systematic literature review was conducted using several databases such as: PubMed; EBSCO; Science Direct; Cochrane and Google Scholar. Data from all selected articles were extracted by two independent reviewers. Relevant parameters explored using Review Manager V5.3. Results: Five comparative studies of staghorn stones involving 384 renal units were analyzed; 176 cases used the UP approach and 208 the NP approach. There was no significant difference in stone-free rate between these approaches, with 74.4% undergoing the UP approach and 71.1% the NP approach considered stone-free (OR: 1.55; 95% CI: 0.92-2.63; P=0.10). The rate of thoracic complications (hydrothorax and pneumothorax) did not differ significantly (OR: 3.14; 95% CI: 0.63-15.62; P=0.16). However, we noted that 5 of 176 patients that underwent the UP approach experienced thoracic complications. The incidence of post-procedural fever and sepsis is similar (OR: 1.18; 95% CI: 0.52-2.64; P=0.69). Neither post-procedural urine leakage (OR: 2.03; 95% CI: 0.70-5.85; P=0.19) nor requirement of blood transfusions (OR: 0.49; 95% CI: 0.14-1.76; P=0.27) differed significantly. Conclusion: PCNL with UP access for staghorn stone has a similar stone-free rate to the NP approach. Thoracic complication rate which was believed to be higher in the UP group is also deemed similar with NP access.
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