Logarakis N F, Jewett M A, Luymes J, Honey R J
Urolithiasis Program, Division of Urology, The University of Toronto, Ontario, Canada.
J Urol. 2000 Mar;163(3):721-5.
We measure and compare operator specific success rates of extracorporeal shock wave lithotripsy (ESWL) performed by 12 urologists in 1 unit to determine interoperator variation.
From January 1, 1994 to September 1, 1997 a total of 5,769 renal and ureteral stones received 9,607 ESWL treatments by 15 urologists with a Dornier MFL 5000 lithotriptor. The 3-month followup data are available for 4,409 stones. Outcome measures consisted of patient demographics, stone characteristics, technical details of lithotripsy, and stone-free and success rates by treating urologists.
Treatment results were analyzed for 12 urologists (surgeons A to L) who treated more than 100 stones each, totaling 4,244 with followup information available. Mean stone-free and success rates were 50.6% and 72.3%, respectively. Surgeon A had significantly higher stone-free and success rates of 56.2% and 76.7%, respectively (p<0.05), with treatment results from 877 stones, which was a significantly higher number than others (p<0.05). Significant differences existed in mean number of shocks delivered among urologists (p = 0.0001), with surgeons A and J delivering the highest mean numbers (2,317 and 2,801, respectively). There was no difference in treatment duration (p = 0.75) but variation existed among urologists in terms of mean maximum treatment voltage (p = 0.0001). Mean fluoroscopy time at 4.1 minutes was higher for surgeon A than others (p<0.05). Mean complication rate following ESWL was 4.9% with no difference among urologists (p = 0.175). Re-treatment was required in 21.7% of cases and surgeon A had the lowest rate (15.9%, p<0.05).
We demonstrated clinically and statistically significant intra-institutional differences in success rates following ESWL. The best results were obtained by the urologist who treated the greatest number of patients, used a high number of shocks and had the longest fluoroscopy time. Accurate targeting is crucial when using a lithotriptor, such as the Dornier MFL 5000, with a narrow focal zone of 6.5 mm. in diameter. Other centers should be encouraged to develop similar programs of outcome analysis in an attempt to improve performance.
我们测量并比较了由12位泌尿科医生在同一科室进行的体外冲击波碎石术（ESWL）的操作者特定成功率，以确定操作者之间的差异。
1994年1月1日至1997年9月1日，15位泌尿科医生使用多尼尔MFL 5〇〇〇型碎石机对5769例肾和输尿管结石进行了9607次ESWL治疗。4409例结石有3个月的随访数据。结果指标包括患者人口统计学资料、结石特征、碎石技术细节以及治疗泌尿科医生的结石清除率和成功率。
对每位治疗超过1〇〇例结石的12位泌尿科医生（外科医生A至L）的治疗结果进行了分析，共有4244例有随访信息。平均结石清除率和成功率分别为5〇.6%和72.3%。外科医生A的结石清除率和成功率显著更高，分别为56.2%和76.7%（P<〇.〇5），治疗了877例结石，这一数量显著高于其他医生（P<〇.〇5）。泌尿科医生之间平均碎石次数存在显著差异（P = 〇.〇〇〇1），外科医生A和J的平均碎石次数最多（分别为2317次和28〇1次）。治疗持续时间无差异（P = 〇.75），但泌尿科医生之间平均最大治疗电压存在差异（P = 〇.〇〇〇1）。外科医生A的平均透视时间为4.1分钟，高于其他医生（P<〇.〇5）。ESWL后的平均并发症发生率为4.9%，泌尿科医生之间无差异（P = 〇.175）。21.7%的病例需要再次治疗，外科医生A的再次治疗率最低（15.9%，P<〇.〇5）。
我们证明了ESWL术后机构内成功率在临床和统计学上存在显著差异。治疗患者数量最多、使用碎石次数多且透视时间最长的泌尿科医生取得了最佳结果。使用多尼尔MFL 5〇〇〇型等焦点区直径仅6.5mm的窄聚焦碎石机时，精确瞄准至关重要。应鼓励其他中心开展类似的结果分析项目，以提高治疗效果。
