通電時間測定器を用いた経尿道的前立腺切除術の切除時間と凝固時間の術者間比較

Abstract

2005年3月-2006年2月までに前立腺肥大症の診断で経尿道的前立腺切除術(TUR-P)を受けた123例を対象に, 経験症例数の異なる術者間でTUR-Pでの切除, 凝固時間の占める割合を検討した。経験症例数約4000例の泌尿器科専門医をA医師, 経験症例数約100例の泌尿器科専門医をB医師, 経験症例数約50例の医師を出張医とし, 各々手術を行った57例, 60例, 6例について, 通電時間測定器を用いて, 切除および凝固の時間と回数を測定した。また切除重量と手術時間を測定し, 切除重量1gあたりの手術時間, 切除および凝固の時間と回数, 手術時間に占める切除・凝固時間の割合を計算した。3群間で比較の結果, 手術時間はA医師, B医師, 出張医の順に有意に長く, 手術時間に占める切除・凝固時間の割合は全体で30%であり, A医師が37%, B医師が27%, 出張医が21%で有意差が見られた。前立腺容積が40ml以下の症例のみを対象としても, A医師が34%, B医師が26%, 出張医が21%で有意差が見られた。経験症例の多い医師ほどTUR-Pの手術時間が短く, 手術時間に占める切除・凝固の割合が高かった。

We investigated resection and coagulation times for 123 patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia who underwent transurethral resection of the prostate (TUR-P) and their differences among surgeons. The numbers of cases of TUR-P in this study were 57 for Doctor A (experienced about 4000 cases), 60 for Doctor B (experienced about 100 cases) and 6 for a visiting physician (experienced about 50 cases). We measured resection and coagulation times by turning on a time-measuring instrument that was made using commercially available parts. There were significant differences in entire operation time, and operation, resection and coagulation times per resected weight of the tissue among the 3 doctors (Doctor A < Doctor B < visiting physician, p < 0.0001, Kruskal-Wallis test). The percentage of total operation time accounted for by resection time and coagulation time in TUR-P was 37% for doctor A, whereas it was 27% for doctor B and that for the visiting physician was 21% (p < 0.0001, Kruskal-Wallis test). Thus, for doctors with more experience resection time and coagulation time accounted for higher percentages of total operation time. The measuring instrument is inexpensive and has the potential to be a useful tool for checking a surgeon's skill.