Tok Adem, Ozturk Savas, Tepeler Abdulkadir, Tefekli Ahmet Hamdi, Kazancioglu Rumeyza, Muslumanoglu Ahmet Yaser
Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey.
Int Urol Nephrol. 2009;41(1):219-23. doi: 10.1007/s11255-008-9482-0. Epub 2008 Oct 25.
Since percutaneous nephrolithotomy (PNL) is a surgical intervention, it may show deteriorative effects on renal function in the early postoperative period. In this study, the deteriorative effects of PNL on renal function were investigated in the geriatric population, and it was compared to the non-geriatric population.A total of 711 patients [64 in the geriatric group (female/male ratio: 33/31, mean age: 70.4 +/- 4.2 years), 647 in the non-geriatric group (female/male ratio: 267/380, mean age: 40.9 +/- 12.7 years)] were included in the study. Demographic data, biochemical parameters, stone diameters, duration of the operation and estimated glomerular filtration rates (eGFR) were recorded both preoperatively and postoperatively.The eGFR ratio (post-/preoperative) was 1.13 +/- 1.00 in the geriatric group, 0.98 +/- 0.20 in the non-geriatric group (P < 0.001). Although the mean stone diameter was larger in the geriatric group than the non-geriatric group (10.08 +/- 6.5 mm, 8.28 +/- 5.54 mm, P = 0.037), the mean duration of the operation was shorter in the geriatric group than in the non-geriatric group (55.7 +/- 13.6 min, 61.3 +/- 20.9 min, P = 0.036). Hematocrit, hemoglobin, urea levels, and grade of hydronephrosis were not different between the groups.Renal function impairment is expected to be common in the geriatric patient population since they already have lower basal renal function. In the present study, the ratio of postoperative to preoperative eGFR was higher in the geriatric group. Hematocrit, hemoglobin, and urea levels and degree of hydronephrosis of these two groups did not show a great difference. The relatively short duration of the operation in the geriatric group and the diversity of perioperative and postoperative care of these two groups may explain the difference.
由于经皮肾镜取石术（PNL）是一种外科干预手段，在术后早期可能会对肾功能产生不良影响。在本研究中，对老年人群中PNL对肾功能的不良影响进行了调查，并与非老年人群进行了比较。
本研究共纳入711例患者[老年组64例（女性/男性比例：33/31，平均年龄：70.4±4.2岁），非老年组647例（女性/男性比例：267/380，平均年龄：40.9±12.7岁）]。记录了术前和术后的人口统计学数据、生化参数、结石直径、手术时间和估计肾小球滤过率（eGFR）。
老年组的eGFR比值（术后/术前）为1.13±1.00，非老年组为0.98±0.20（P<0.001）。尽管老年组的平均结石直径大于非老年组（10.08±6.5mm，8.28±5.54mm，P=0.037），但老年组的平均手术时间比非老年组短（55.7±13.6分钟，61.3±20.9分钟，P=0.036）。两组之间的血细胞比容、血红蛋白、尿素水平和肾积水程度无差异。
由于老年患者群体的基础肾功能已经较低，预计肾功能损害在该群体中较为常见。在本研究中，老年组术后与术前eGFR的比值更高。这两组的血细胞比容、血红蛋白和尿素水平以及肾积水程度没有显著差异。老年组相对较短的手术时间以及这两组围手术期和术后护理的差异可能解释了这种差异。
