| Objective:To explore the perioperative management of ureteroscopicholmium laser lithotripsy for treatment of ureteral calculi in the elderly andto analyze the therapeutic effect as well.Methods:To retrospectively annlyze the clinical date of62cases(67sides) in the elderly of ureteral calculi with ureteroscopic holmium laserlithotripsy in the branch of the first hospital of jilin university fromSeptember2012to September2013.And85patients of non elderly duringthe same period were chosen as control.The There were35men and27women in the elderly patients group,aged from60to81years(average age69.3±7.1years). Non elderly patients group had48men and37women,aged from18to59years(average age37.1±12.2years). Patients ofelderly group with both sides have ureteral calculi were5cases,and therewere15sides with upper ureteral calculi,23sides with middle ureteralcalculi,29sides with lower ureteral calculi;9sides accompanied withpolyps,ESWL failure25sides. Patients of non elderly group with bothsides have ureteral calculi were8cases,the calculi of upper, middle andlower ureter were24,27and42sides,and10sides of them accompaniedwith polyps,28sides were ESWL failure.Among the elderly patients groupthere were22cases accompanied with hypertension,12with heart disease,7with diabetes,11with lung diseases,6with central nerve system disease,2with malnutrition,10with urinary infection. Full preoperative preparationmust be carried out, controlling blood pressure, blood sugar,infection andso on. The operation was performed under general anesthesia.The ureteralcalculi was crushed under2millimeters,the resection of ureteral polyps and the incision of stricture segment would be carried out as well. Ureteric stentwas used after surgery for2to4weeks as well as catheterindwelled.The careful postoperative nursing must be given aftersurgery,and the problem would be handled as soon as it comes out.Results:Surgery time of elderly patients group was21-85minutes(average36.2±9.5minutes),and the total lithotripsy success ratewas89.6%（60/67）,the success rate of the upper,middle,lower ureteralcalculi was80.8%（12/15）,91.3%（21/23）,93.1%（27/29）, the casesaccompanied with polyps was77.8%（7/9）, ESWL failure was88.0%（22/25）.The non elderly patients group’s surgery time was19-80minutes(average35.6±8.8minutes), the total lithotripsy success rate was91.4%（85/93）,the upper,middle,lower ureteral calculi lithotripsy successrate was83.3%（20/24）,92.6%（25/27）,95.2%（40/42）, the casesaccompanied with polyps was80.0%（8/10）, ESWL failure was89.3%（25/28）.Ureteral injury,ureteral perforation, ureteral mcosapseudocanal,gross hematuria, ostoperative pyrexia and osphyalgia werefound in4,3,1,10,9and6cases of the elderly patients group;And therewere4,5,11,7and5cases with ureteral injury,ureteral perforation, grosshematuria, ostoperative pyrexia and osphyalgia were found in non elderlypatients group.The analysis of two group’s date suggest that there are nosignificant difference of two group with the lithotripsy success rate andcomplication rate.We can see that the effect of ureteroscopic holmium laserlithotripsy for treatment of aged ureteral calculi is comparable to the nonelderly patients,and have high curative effect,and also can be used for thecomplicated ureteral calculi(accompanied with polyps, ESWL failure)ofaged people. The reexamination after4weeks revealed the stone free ratewas96.7%（58/60）,97.6%（83/85） of the two group. We have thepostoperative follow-up for3to6months.1case with calculi recurrence of elderly patients group(URLS again),and1case with ureteral stricture ofnon elderly patients group(surgery of balloon dilation was success).Conclusion:There will be low risk of ureteroscopic holmium laserlithotripsy for treatment of aged ureteral calculi after full perioperativemanagement was carried out;and the ureteroscopic holmium laserlithotripsy for treatment of aged ureteral calculi have the same effect withnon non elderly patient;and can be also used for the complicated ureteralcalculi of aged people. |
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