Crowley A R, Horowitz M, Chan E, Macchia R J
Department of Urology, Brooklyn Veterans Administration Medical Center, New York.
J Urol. 1995 Mar;153(3 Pt 1):695-7. doi: 10.1097/00005392-199503000-00041.
To determine whether transurethral prostatectomy results in higher long-term mortality rates than open prostatectomy, we reviewed retrospectively 1,125 patients treated by transurethral and 190 treated by nonperineal open prostatectomy for benign disease at 1 institution from 1978 through 1987. Patients in whom prostatic cancer was found were excluded. We identified age, preoperative medical illnesses and urinary retention, American Society of Anesthesiologists category, type of anesthesia, length of followup, health status and cause of death. For statistical analysis the study cohort consisted of 527 patients in whom the charts were complete and followup was adequate (421 in the transurethral prostatectomy and 106 in the open prostatectomy groups). Mean age for the 2 groups was 66.3 and 67.5 years, respectively. With an average followup of 70.7 months 77% of the transurethral prostatectomy group were alive, compared to 78% of the open prostatectomy group at an average followup of 71.4 months. We found no supportive evidence that transurethral prostatectomy results in higher long-term mortality rates than does an open operation (log-rank test p = 0.74). Also, there was no significant survival difference in patients who required a preoperative Foley catheter. We also examined a subset of patients with adequate followup who had no significant medical history (for example hypertension, diabetes, heart disease and so forth) and compared them to patients with medical illnesses at prostatectomy. There was a significant survival difference between those with and without preoperative medical conditions (Wilcoxon test p = 0.047) in the transurethral prostatectomy group but not in the open group (p = 0.58). However, there was no significant survival difference between procedures among the healthiest subset of patients (p = 0.16).
为确定经尿道前列腺切除术是否比开放性前列腺切除术导致更高的长期死亡率，我们回顾性分析了1978年至1987年期间在一家机构接受经尿道前列腺切除术治疗的1125例患者和接受非会阴开放性前列腺切除术治疗的190例良性疾病患者。排除发现前列腺癌的患者。我们确定了年龄、术前内科疾病和尿潴留情况、美国麻醉医师协会分级、麻醉类型、随访时间、健康状况和死亡原因。为进行统计分析，研究队列包括527例病历完整且随访充分的患者（经尿道前列腺切除术组421例，开放性前列腺切除术组106例）。两组的平均年龄分别为66.3岁和67.5岁。经尿道前列腺切除术组平均随访70.7个月，77%的患者存活；开放性前列腺切除术组平均随访71.4个月，78%的患者存活。我们未发现支持经尿道前列腺切除术比开放性手术导致更高长期死亡率的证据（对数秩检验p = 0.74）。此外，术前需要留置Foley导尿管的患者在生存率上无显著差异。我们还检查了一组随访充分且无重大病史（如高血压、糖尿病、心脏病等）的患者子集，并将他们与前列腺切除术前有内科疾病的患者进行比较。经尿道前列腺切除术组术前有内科疾病和无内科疾病的患者在生存率上存在显著差异（Wilcoxon检验p = 0.047），而开放性手术组则无差异（p = 0.58）。然而，在最健康的患者子集中，两种手术方式在生存率上无显著差异（p = 0.16）。
