老年人上尿路结石经皮取石术的疗效观察

Minimally invasive percutaneous nephrolithotomy in the treatment of upper urinary tract calculi in elderly patients

目的观察微创经皮肾取石术治疗老年人上尿路结石的安全性和疗效。方法回顾性总结2004年1月至2006年6月，在我科接受微创经皮肾取石术治疗的144例年龄≥65岁的上尿路结石患者的临床资料。结果118例采用椎管内麻醉，26例采用气管内全麻。俯卧位手术133例，仰侧卧位手术11例。24例因手术时间长、出血严重影响视野等情况及时终止手术并采用单侧分期手术。手术时间18～197min，平均68min。住院时间8～21d，平均11d。出院前复查结石清除率为82．6％（119／144）。有3例（2．1％）肾结石患者因出血较多，均输血400ml，其中1例行介入栓塞治愈。术后感染引起体温38．5℃以上者31例（21．5％）。术后手术部位疼痛需镇痛处理者27例（18．8％）。术后肾功能持续下降者1例。结论经充分的术前准备、合理选择分期手术、恰当的术后处理，微创经皮肾取石术是安全、效果确切的治疗老年上尿路结石的手术方法。

Objective To investigate the security, efficiency and experience of minimally invasive percutaneous nephrolithotomy（MPCNL） in treatment of elderly patients with upper urinary calculi. Methods The clinical data of the 144 elderly patients with upper urinary tract calculi treated with MPCNL from Februry 2004 to June 2006, were summarized retrospectively. Results One hundred and eighteen patients accepted spinal anesthesia and 26 cases accepted general anesthesia. One hundred and thirty-three patients＇ body position were supine and 11 cases were prone during the operation. Operations suspended in 24 patients because of too long of the operation time, severe haemorrhage blurring the visual field and so on. The operation time was from 18 minutes to 197 minutes and averaged 68 minutes. The length of stay in hospital was from 8 days to 21 days and averaged 11 days. The stone-free rate was 82.6% （119/144） before discharged, 3（2.1%）patients needed blood transfusion because of gross haemorrrhage and 1 patient accepted the intervention embolism of the branch of renal artery, 31 （21.5%）patients had fever over 38. 5＂C because of postoperative infection, 27（18. 8%）cases needed analgesia therapy, 1 patient suffered from persistent descent of renal function. Conclusions Under sufficient preoperation preparation, staging operation and suitable postoperative therapy, MPCNL is a safe and efficient method in treatment of upper urinary calculi in elderly patients.