Malenka D J, Roos N, Fisher E S, McLerran D, Whaley F S, Barry M J, Bruskewitz R, Wennberg J E
Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire 03756.
J Urol. 1990 Aug;144(2 Pt 1):224-7; discussion 228. doi: 10.1016/s0022-5347(17)39416-8.
Previous studies using large administrative databases found an elevated relative risk of reoperation and death after transurethral resection of the prostate compared to open prostatectomy. To investigate whether differences in case-mix unmeasured by administrative data explained this finding, we reviewed the charts of 485 patients who had undergone prostatectomy (236 open and 249 transurethral) at the Health Science Centre, Winnipeg, Manitoba, Canada between 1974 and 1980. Data from patient histories, physical examinations and laboratory evaluations were abstracted and used to control for case-mix in models comparing the rates of reoperation and mortality after transurethral versus open prostatectomy. Several models were specified. In all models the relative risk of dying after transurethral prostatectomy remained elevated (1.36 to 1.89), as did the risk for reoperation (3.62). A prospective trial is needed to establish the relative safety and effectiveness of transurethral and open prostatectomy.
以往使用大型管理数据库的研究发现，与开放性前列腺切除术相比，经尿道前列腺电切术后再次手术和死亡的相对风险有所升高。为了调查管理数据未测量的病例组合差异是否能解释这一发现，我们回顾了1974年至1980年间在加拿大曼尼托巴省温尼伯市健康科学中心接受前列腺切除术的485例患者（236例开放性手术和249例经尿道手术）的病历。从患者病史、体格检查和实验室评估中提取数据，并用于在比较经尿道前列腺切除术与开放性前列腺切除术后再次手术率和死亡率的模型中控制病例组合。设定了几个模型。在所有模型中，经尿道前列腺切除术后死亡的相对风险仍然较高（1.36至1.89），再次手术的风险也是如此（3.62）。需要进行一项前瞻性试验来确定经尿道前列腺切除术和开放性前列腺切除术的相对安全性和有效性。
