The Royal Melbourne Hospital, Parkville, Victoria, Australia.
J Endourol. 2011 Feb;25(2):251-6. doi: 10.1089/end.2010.0384. Epub 2010 Nov 10.
Laparoscopic pyeloplasty (LP) has been described as the new gold standard operation for patients with ureteropelvic junction obstruction (UPJO). As life expectancy continues to increase, we will be faced with the need to counsel older patients on the risks and benefits of undergoing surgery. It is clear that laparoscopic renal surgery has significant benefits over open renal surgery. Avoidance of open surgery would seem particularly beneficial in elderly patients who receive a diagnosis of this condition, although results in this group have not been formally studied. We compared the perioperative and medium-term outcomes of LP for primary UPJO in patients who are 70 years and older with those who are under age 70.
Between January 2006 and June 2009, 74 consecutive patients underwent LP for UPJO performed by one surgeon. A four-port extraperitoneal approach was used in all but one case. Patient demographic and perioperative data were recorded prospectively. Outcome measures were success rate at a median follow-up of 12 months, complications, and length of hospital stay.
Fifteen (20%) patients were aged 70 years or older. Older patients had a higher median American Society of Anesthesiologists score (2 vs 1). Moreover, older patients often presented with compromised renal function than their younger counterparts (median split renal function on the affected kidney 35% vs 45%, serum creatinine level 130 vs 90 μmol/L, P < 0.001). The success rate in the older group was 87%, with no treatment failures in the younger patients. Median hospital stay was longer for older patients (3 days vs 2 days, P = 0.01). Frequency of complications were not significantly different between the groups; however, there was a postoperative death in an elderly patient with a solitary kidney and preoperative renal failure.
LP is feasible with generally good results for managing UPJO in patients 70 years or older. Older patients, however, are likely to need a longer hospital stay compared with their younger counterparts, and their co-morbidities should be carefully assessed preoperatively to minimize morbidity. Advanced chronologic age should not be a contraindication for LP in patients with symptomatic UPJO.
腹腔镜肾盂成形术（LP）已被描述为治疗肾盂输尿管连接部梗阻（UPJO）患者的新标准手术。随着预期寿命的不断延长，我们将需要向老年患者提供有关手术风险和益处的咨询。显然，腹腔镜肾脏手术比开放肾脏手术具有明显的优势。对于接受这种疾病诊断的老年患者来说，避免开放性手术似乎特别有益，尽管这一人群的结果尚未得到正式研究。我们比较了 70 岁及以上与 70 岁以下的原发性 UPJO 患者行 LP 的围手术期和中期结果。
2006 年 1 月至 2009 年 6 月，一位外科医生对 74 例连续接受 UPJO 腹腔镜肾盂成形术的患者进行了手术。除 1 例外，所有患者均采用四孔经腹腹腔镜手术。前瞻性记录患者的人口统计学和围手术期数据。评估指标为中位随访 12 个月时的成功率、并发症和住院时间。
15 例（20%）患者年龄在 70 岁或以上。老年患者的美国麻醉医师协会评分中位数较高（2 分与 1 分）。此外，与年轻患者相比，老年患者的肾功能往往受损（受影响肾脏的中位数肾功能分为 35%与 45%，血清肌酐水平为 130 与 90 μmol/L，P<0.001）。老年组的成功率为 87%，年轻组无治疗失败。老年患者的中位住院时间较长（3 天与 2 天，P=0.01）。两组的并发症发生率无显著差异；然而，在一名患有孤立肾和术前肾功能衰竭的老年患者中，术后发生了死亡。
对于 70 岁或以上的 UPJO 患者，LP 是可行的，且结果总体良好。然而，与年轻患者相比，老年患者可能需要更长的住院时间，并且术前应仔细评估其合并症，以尽量减少发病率。对于有症状的 UPJO 患者，高龄不应成为 LP 的禁忌症。
