Páez Borda A, Prieto Chaparro L, Salinas Casado J, del Corral Rosillo J, Rápariz González M, Fernández Lucas C, Moreno Sierra J, Nacarino Corbacho L, Resel Estévez L
Cátedra de Urología, Hospital Universitario San Carlo (HUSC), Universidad Complutense, Madrid.
Arch Esp Urol. 1992 May;45(4):321-8.
We reviewed the records of 277 patients aged 80 or older that had been considered for surgery during the period 1980-1990. We analyzed the surgical risk (Goldman and ASA score), patient history, type of surgery and the post-operative course (Karnofsky index) in order to identify the risk factors and to permit objective and practical selection of patients amenable to surgical treatment. Overall, regardless of sex, the benign (35%) and malignant (18%) diseases of the prostate and bladder neoplasms (30%) accounted for more than 80% of the surgical procedures. The early postoperative complications were shown to be influenced by the type of surgery (emergency surgery), the approach (open surgery), the presence of preoperative urinary tract infections and the ASA score. Regardless of the cure rate, the analysis of the postoperative course and data gleaned from telephone interviews indicate that 61.5% of the patients probably had a very good or good quality of life at 6 months. In the non-operated group 1 out of 10 procedures that had been anticipated was not performed and many had a malignant disease. Although there were more patients with fair/poor quality of life in the patient group that did not undergo surgery than in the operated group (42.8% versus 28.5%, respectively), patient general condition at 6 months was very good or good in 50% of the patients that were followed or interviewed. The use of the preoperative evaluation methods and our clinical experience can eliminate subjective evaluation and permit developing safe and precise surgical programs.
我们回顾了1980年至1990年期间277名年龄在80岁及以上且曾考虑接受手术的患者的记录。我们分析了手术风险（Goldman和ASA评分）、患者病史、手术类型及术后病程（Karnofsky指数），以确定风险因素，并客观、实际地筛选适合手术治疗的患者。总体而言，无论性别，前列腺和膀胱肿瘤的良性疾病（35%）、恶性疾病（18%）占手术操作的80%以上。术后早期并发症受手术类型（急诊手术）、手术入路（开放手术）、术前尿路感染的存在情况及ASA评分的影响。无论治愈率如何，对术后病程的分析以及电话访谈收集的数据表明，61.5%的患者在6个月时生活质量可能非常好或良好。在未手术组中，预期的10例手术中有1例未进行，且许多患者患有恶性疾病。虽然未接受手术的患者组中生活质量一般/较差的患者比手术组多（分别为42.8%和28.5%），但在接受随访或访谈的患者中，50%的患者在6个月时一般状况非常好或良好。术前评估方法的使用和我们的临床经验可以消除主观评估，并制定安全、精确的手术方案。
