Gupta Rahul, Mahajan Arti
Department of Urology, Government Medical College, Jammu, Jammu and Kashmir, India.
Department of Anesthesia, Government Medical College, Jammu, Jammu and Kashmir, India.
Urol Ann. 2020 Jul-Sep;12(3):254-258. doi: 10.4103/UA.UA_69_19. Epub 2020 Jul 17.
Surgical management of elderly patients with renal calculi is inherently challenging. We compared the efficacy and safety of percutaneous nephrolithotomy (PCNL) performed under regional anesthesia between elderly patients (age >65 years) and patients aged <65 years.
Between July 2015 and June 2016, fifty patients aged >65 years with renal stones (size >1.5 cm) were treated with PCNL under regional anesthesia (elderly group). We retrospectively compared the outcomes with those obtained in an equal number of patients aged <65 years (younger group) who underwent PCNL under regional anesthesia. Patients with staghorn stones and pyonephrosis and falling under the American Society of Anesthesiologists (ASA) Grade IV were excluded. Data pertaining to demographic characteristics, body mass index, stone bulk, operative time, tract size, number of tracts required, blood loss, clearance rates, complications, and length of hospital stay were analyzed.
The mean age at presentation in the elderly and younger groups was 66.8 ± 2.1 years and 38.7 ± 11 years, respectively; 56% of the patients in the elderly age group had ASA Grade II, whereas 58% in the younger age group had ASA Grade I. The mean stone size and the number of tracts were comparable in both the groups, whereas operative time was slightly longer in the elderly group (58.54 ± 18 vs. 51.98 ± 18 min; < 0.05). Postoperative complications and stone-free rates (94% vs. 92%, respectively) were comparable in the two groups.
Age itself should not deter the treatment of elderly patients with renal stones as PCNL under regional anesthesia is safe and effective in elderly patients; outcomes in elderly and younger patients were comparable in this study.
老年肾结石患者的手术治疗具有内在挑战性。我们比较了老年患者（年龄>65岁）和<65岁患者在区域麻醉下进行经皮肾镜取石术（PCNL）的疗效和安全性。
2015年7月至2016年6月，50例年龄>65岁的肾结石患者（结石大小>1.5 cm）在区域麻醉下接受PCNL治疗（老年组）。我们回顾性比较了相同数量的<65岁患者（年轻组）在区域麻醉下接受PCNL的结果。排除鹿角形结石、肾积脓且属于美国麻醉医师协会（ASA）IV级的患者。分析了人口统计学特征、体重指数、结石体积、手术时间、通道大小、所需通道数量、失血量、清除率、并发症和住院时间等数据。
老年组和年轻组患者的平均就诊年龄分别为66.8±2.1岁和38.7±11岁；老年年龄组56%的患者为ASA II级，而年轻年龄组58%的患者为ASA I级。两组的平均结石大小和通道数量相当，而老年组的手术时间略长（58.54±18 vs. 51.98±18分钟；<0.05）。两组术后并发症和结石清除率（分别为94%和92%）相当。
年龄本身不应阻碍老年肾结石患者的治疗，因为区域麻醉下的PCNL对老年患者是安全有效的；本研究中老年患者和年轻患者的结果相当。
