単独医による4,031例の経尿道的前立腺切除術の検討 : 学習曲線,手術成績と術後合併症

Abstract

前立腺切除術(TURP)症例数を第I群:1979～1983年の215例, 第II群:1984～1993年の2074例, 第III群:1994～2003年の1742例に分類し, TURP技術の熟練度と経験症例数, 切除速度との関係を学習(経験)曲線で検討した.経験症例数が81例に達するまでの技術学習・習得期中は累積症例数の増加に比例して手術速度が大きく上昇し, 81例を超えた時から習熟・熟練期に入り, 安定した速度で手術が完了することを示した.第I, II, III群の順に手術時間は短縮し, 切除速度は有意に増加したが切除重量との関係は認められなかった.合併症の頻度は輸血2.4%, TURP症候群0.3%, 止血処置1.5%, 膀胱頸部拘縮2.8%, 尿道狭窄10%, 死亡は0.1%であった

A total of 4, 031 patients who underwent transurethral resection of the prostate (TURP) performed by one surgeon between May 1979 and December 2003 were retrospectively examined to determine the improvement of the surgeon's skill in performing TURP assessed by using a learning curve, surgical results and postoperative complications. Analysis using the learning curve, which displayed the relationship between the number of TURP procedures and the speed of resection (i.e., the weight of tissue resected divided by the operation time), revealed that 81 operations were needed before the surgeon's skill reached a plateau in performing TURP. The means +/- standard deviations of the weight of tissue resected, operation time and speed of resection were 17.0 +/- 14.6 g, 21.0 +/- 13.5 minutes, 0.80 +/- 0.32 g/minutes, respectively. As the number of TURP procedures increased and the level of skill improved, the operation time was significantly reduced and the speed of resection was significantly increased. The incidences of postoperative complications were 2.4% for blood transfusion, 0.3% for the TURP syndrome, 1.5% for hemostatic procedures, 2.8% for bladder neck contracture, and 1.0% for urethral stricture. The incidences of transfusion and the TURP syndrome decreased as the surgeon's skill improved. The mortality rate was 0.1%.