Lim Kylie Yen-Yi, Liew Amos Nepacina, Ling Zihui, Ranasinghe Weranja, McCahy Philip
Department of Urology, Monash Health, Melbourne, VIC 3168, Australia.
School of Medicine, Monash University, Clayton, VIC 3800, Australia.
J Clin Med. 2023 Jul 21;12(14):4807. doi: 10.3390/jcm12144807.
With increases in the aging population, conditions affecting older people and relevant surgical techniques are becoming more pertinent. Modified supine percutaneous nephrolithotomy (PCNL) is increasingly being adopted. There are limited data on the safety of this position in the elderly patient population. We describe our experience of the modified supine position in patients aged 70 years and older. Between April 2011 and March 2021, patients aged 70 years and older undergoing a modified supine PCNL performed by a single surgeon were prospectively evaluated. Data including patient age, operative time, complications, stone clearance, and length of stay were collected and analysed. Sixty-nine procedures were performed on 67 patients with a mean age was 76.5 years. Median total operative time was 95 min with 20 (29%) patients having a combined procedure with ureterorenoscopy. Preoperative mean stone burden was 23.5 mm and complete stone clearance was achieved in 46 (66.7%) patients. Twelve (17.4%) patients had complications during their hospitalisation. Six were Clavien-Dindo class II or less and one Clavien-Dindo class V. The modified supine position for PCNL is safe in the elderly patient population and has advantages including reduced handling of patients and achieving adequate stone-free rates. These benefits are particularly important in the elderly population, which frequently has a reduced tolerance to adaptation.
随着老年人口的增加，影响老年人的疾病及相关手术技术变得愈发重要。改良仰卧位经皮肾镜取石术（PCNL）的应用越来越广泛。关于该体位在老年患者群体中的安全性数据有限。我们描述了我们在70岁及以上患者中采用改良仰卧位的经验。在2011年4月至2021年3月期间，对由单一外科医生实施改良仰卧位PCNL的70岁及以上患者进行了前瞻性评估。收集并分析了包括患者年龄、手术时间、并发症、结石清除率和住院时间等数据。对67例患者实施了69例手术，平均年龄为76.5岁。中位总手术时间为95分钟，20例（29%）患者接受了输尿管肾镜联合手术。术前平均结石负荷为23.5毫米，46例（66.7%）患者实现了结石完全清除。12例（17.4%）患者在住院期间出现并发症。6例为Clavien-Dindo二级或以下，1例为Clavien-Dindo五级。PCNL的改良仰卧位在老年患者群体中是安全的，具有减少患者搬运和实现足够无石率等优点。这些益处对于耐受性通常降低的老年人群尤为重要。
