urovestВестник урологииUrology Herald2308-6424Rostov State Medical University10.21886/2308-6424-2016-0-3-81-125urovest-103Research ArticleПРИЛОЖЕНИЕAPPLICATIONРЕЗУЛЬТАТЫ РАДИКАЛЬНОЙ ЦИСТОПРОСТАТОВЕЗИКУЛЭКТОМИИ У ПОЖИЛЫХ ПАЦИЕНТОВRESULTS OF RADICAL CYSTPROSTATVESICULECTOMY IN OLD PATIENTSМенджерицкийА.MendzheritskyA.

Медицинский факультет 

Кафедра урологии и центр трансплантации почки

ФорнараП.FornaraP.

Медицинский факультет 

Кафедра урологии и центр трансплантации почки

Университет Мартина Лютера, Галле-ВиттенбергRussian Federation2016200920160381125Copyright © Менджерицкий А., Форнара П., 20162016Менджерицкий А., Форнара П.Mendzheritsky A., Fornara P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.urovest.ru/jour/article/view/103

Резюме. В результате увеличения продолжительности жизни показания к радикальной цистэктомии ставятся все чаще и чаще. Пожилые мультиморбидные пациенты не являются исключением. Целью данной работы является оценка цистэктомии у пациентов старше 70 лет. При помощи сравнительного анализа двух групп пациентов 70-75 лет (I группа) и старше 75 лет (группа II) были оценены следующие параметры: предоперационное заболеваемость (индекс коморбидности Чарлсона), продолжительность пребывания в стационаре, частота переливания крови, ранние и поздние осложнения, смертность и продолжительность жизни после операции. Было установлено, что пациенты старше 75 лет, которые имели более отягащенный кардиопульмональный анамнез находились дольше в стационаре и чаще получале перелевание крови. Ранние и поздние осложнения, которые оценивались при помощи классификации Клавиен-Диндо были одинаковыми в обеих группах. В то же время терапевтические и большие осложнения (Клавиен-Диндо 3-5) доминировали в группе пациентов старше 75 лет. Более молодые пациенты жили вдвое дольше, чем пожилые пациенты. При одинаковой 30 дневной смертности в обеих группах, 90 дневная смертность была выше в старшей возрастной группе. 5-летняя выживаемость была достоверно выше в группе I. Таким образом, к радикальной цистэктомии следует стремиться и в более позднем возрасте, даже у мультиморбидных пациентов после точной стратификации рисков и оценки индивидуального биологического состояния, ожидая при этом более высокие но приемлемые показатели осложнений и смертности. 

Abstract. As a result of rising life expectancy the indication for radical cystectomy is registered more and more frequently also in elderly and multimorbid patients. This work is aimed to estimate the importance of cystectomy in patients older than 70 years. The study was designed as a comparative analysis of two patients groups of 70-75 (group I) and over 75 (group II) years old with respect to following parameters: preoperative morbidity (Charlson Comorbidity-index), stat. length of hospital stay, transfusion rate, early and late complications, mortality and postoperative life expectancy. The data revealed that patients over 75 years old, who were higher cardiopulmonary preloaded, had a longer hospital stay and exhibited a higher transfusion rate. The early and late complication rates, assessed with the Clavien-Dindo classification, were identical in both groups. At the same time the internal medicine and major complications (CDC 3-5) dominated in the group of over 75 years old patients. The younger patients lived twice as long as the older patients. While having the same 30 days mortality in both groups, the 90 days mortality was higher in the older group. The 5-year survival was significantly higher in the group I. Thus, the radical cystectomy should be strived in older age expecting acceptable higher complication rates and mortality even in multi-morbid patients after more accurately risk stratification and evaluation of individual biological constellation. 

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The authors declare that there are no conflicts of interest present.