经皮肾镜取石术治疗70岁以上高龄肾结石患者的安全性分析

The safety analysis of percutaneous nephrolithotomy in elderly patients（age≥70 years）

目的分析70岁以上高龄复杂肾结石患者经皮肾镜取石术（PCNL）的安全性。方法总结我院2008—06—2011-06间58例年龄≥70岁高龄肾结石并行PCNL患者的临床资料，评价术前结石最大直径、结石数量、并发症情况、手术时间、手术成功率、结石取净率、术后血红蛋白下降值、住院时间、并发症等指标，并与同期215例年龄20～40岁年轻肾结石PCNL患者对比，分析70岁以上高龄患者PCNL的安全性。结果高龄组58例手术全部成功，青年组手术成功214例（99．5％）（P=0．60）；高龄组和青年组一期结石取净分别为49例（84．5％）、190例（88．4％）（P=0．39）；手术时间分别为（65．5±13．8）min、（60．7±12．3）min（P=0．65）；术后血红蛋白下降值分别为（15．0±8．0）g／L、（13．0±7．0）g／L（P=0．78）；住院时间分别为（8．5±3．7）d、（7．6±3．5）d（P=0．49）；并发症如术中出血、肾周血肿、邻近器官损伤、肾盂穿孔、术后发热、术后迟发性出血等两组差异均无统计学意义（P〉0．05）。结论采用个体化的围手术期风险控制及防范措施，PCNL治疗70岁以上高龄肾结石患者仍然是一种安全有效的方法。

Objective To analyze the safety of percutaneous nephrolithotomy（PCNL） in elderly patients （ age ≥ 70 years）. Methods We retrospectively reviewed 58 PCNLs performed in the elderly patients （age ≥70 years） carried out during June 2008 to June 2011 and compared those with 215 PCNLs performed in younger patients （age 20-40 years） during the same period. Results The operation success rates were 100% for the elderly patients and 99.5% for the younger patients （P=0.60）. The stone-free rates were 84.5% and 88.4% （P=0.39）,and the operative time was 65.5 ± 13.8 minutes and 60.7 ± 12.3 minutes （P= 0.65） in the elderly and younger patients, respectively. The mean hemoglobin level decrease was 1.5±0.8 mg/dL and 1.3±0.7 mg/dL（P=0. 78）, and the mean hospital stay was 8. 5523.7 days and 7.6±3.5 days （P=0. 49）, respectively. No significant difference was seen in complications between the two groups（ P〉0.05）. Conclusion By use of individual risk controlling strategy and precaution- ary measure in perioperative period, PCNL in elderly patients （age≥70 years） may be safe and effective.