使用Guy’s計分系統及查爾森共病積分預測老年人接受經皮腎截石術之預後
曾仁澍1、林文榮1、孫芳如1,3、林祖鋒1、蔡維恭1,2、江百凱1,2、李致樵1、陳鈺昕1、邱文祥1,4、陳建志1-3
1馬偕紀念醫院 泌尿科；2馬偕醫學院；
3馬偕醫護管理專科學校化妝品應用與管理科；4陽明醫學院
Predicting percutaneous nephrolithotomy outcomes and complications in elderly patients using Guy’s scoring system and Charlson comorbidity index
Jen-Shu Tseng1, Wun-Rong Lin1, Fang-Ju Sun1,3, Tsu-Feng Lin1, Wei-Kung Tsai1,2, Pai-Kai Chiang1,2, Chih-Chiao Lee1, Yu-Hsin Chen1, Allen W. Chiu1,4, Marcelo Chen1-3
1 Department of Urology, MacKay Memorial Hospital; 2 School of Medicine, MacKay Medical College; 3 Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing and Management; 4 School of Medicine, National Yang-Ming University, Taipei, Taiwan
Purpose: This study compared the operative outcomes of percutaneous nephrolithotomy in elderly patients with different comorbidity status and different stone complexity.
Materials and Methods: A retrospective review of medical records was performed of 113 patients aged 65 years or older with large renal stones who underwent percutaneous nephrolithotomy between 2007 and 2016. Patients were stratified by comorbidity status using the Charlson comorbidity index and by stone complexity using the Guy’s score. The demographic data, stone parameters, stone-free rates, and complication rates were compared. Factors associated with complications and stone free rate were analyzed using logistic regression.
Results: Patients with higher Charlson comorbidity index were older, used more anticoagulant medications, had higher ASA score, had longer operative times, and had longer hospital stay. Patients with higher Guy’s score had higher stone burden, longer operative times, and a more significant decrease in GFR postoperatively. Logistic regression found that pre-operative pyuria and higher Charlson comorbidity index increased the risk of overall complications, and higher stone burden and higher Guy’s score were associated with decreased stone free rates.
Conclusion: This study supported the use of the Charlson comorbidity index in predicting post-operative complications and the Guy’s score in predicting stone-free status in elderly patients with large renal stones undergoing percutaneous nephrolithotomy.