Hargreave T B, Heynes C F, Kendrick S W, Whyte B, Clarke J A
Information and Statistics Division, National Health Service, Scotland.
Br J Urol. 1996 Apr;77(4):547-53. doi: 10.1046/j.1464-410x.1996.95012.x.
To use the linked medical and death records in Scotland to investigate the possible increased mortality that has been reported after transurethral prostatectomy (TURP) compared with open prostatectomy.
Scotland has maintained linkable hospital, cancer and death records for more than 20 years, representing one of the largest such databases in the world. From these computerized records, data on various cohorts of men aged 55-84 years selected from 81,997 men who underwent prostatectomy in Scotland between 1968 and 1989 were analysed. The risk of late mortality was calculated for each type of operation, whether there was prior comorbidity and for a range of specific causes (cancer, respiratory and circulatory conditions) after prostatectomy.
Among the largest cohort, consisting of 65,519 men who underwent prostatectomy between 1968 and June 1989, the relative risk of late mortality after TURP compared with open prostatectomy was 1.13 (95% CI, 1.10-1.16), after controlling for age and the presence of a diagnosis of cancer. A more restricted cohort of 18,732 men who underwent prostatectomy between 1974 and 1979 allowed adjustment for prior hospitalization with, or concurrent diagnosis of, circulatory and respiratory conditions. In this cohort, the relative risk of late mortality after TURP as compared with open prostatectomy was 1.15 (95% CI, 1.11-1.19) after adjusting for prior and comorbidity and age. Finally, a cohort of 'healthy patients' restricted to the 6932 men who underwent prostatectomy from 1974 to 1979 and with no evidence of hospitalization in the previous 5 years or any current diagnosis other than benign hypertrophy of the prostate, showed a relative risk of 1.14 (95% CI, 1.07-1.21). There was no evidence of an increased risk of dying from circulatory disease in general, ischaemic heart disease or acute myocardial infarction after TURP as opposed to open prostatectomy. However, there was an increased risk of dying from respiratory conditions and from cancer, especially of the prostate and bladder. The analysis suggested the possibility that open prostatectomy may have cured some patients with early prostatic cancer, because the late death rate from prostatic cancer was greater in patients who underwent TURP than open prostatectomy.
The present analysis confirmed the increased risk of late mortality after TURP compared with open prostatectomy, as shown in previous studies based on administrative records. However, limitations in the coding of comorbidities and the absence of coding of more subtle aspects of the condition of the patient which may influence the choice between the forms of prostatectomy mean that the differential mortality after the two procedures could still be a reflection of the pre-operative selection of patients rather than the effects of the surgical procedure.
利用苏格兰的医学与死亡记录联动系统，调查经尿道前列腺切除术（TURP）与开放性前列腺切除术相比，是否存在已报道的可能增加的死亡率。
苏格兰已维持可联动的医院、癌症及死亡记录超过20年，这是世界上最大的此类数据库之一。从这些计算机化记录中，分析了从1968年至1989年在苏格兰接受前列腺切除术的81997名男性中选取的55 - 84岁不同队列男性的数据。计算了每种手术类型、是否存在术前合并症以及前列腺切除术后一系列特定病因（癌症、呼吸系统和循环系统疾病）的晚期死亡风险。
在最大的队列中，由1968年至1989年6月间接受前列腺切除术的65519名男性组成，在控制年龄和癌症诊断情况后，TURP术后晚期死亡的相对风险与开放性前列腺切除术相比为1.13（95%可信区间，1.10 - 1.16）。一个更受限的队列由1974年至1979年间接受前列腺切除术的18732名男性组成，可对循环系统和呼吸系统疾病的术前住院或同期诊断情况进行调整。在这个队列中，调整术前合并症和年龄后，TURP术后晚期死亡的相对风险与开放性前列腺切除术相比为1.15（95%可信区间，1.11 - 1.19）。最后，一个“健康患者”队列限定为1974年至1979年间接受前列腺切除术且在过去5年无住院证据或除前列腺良性增生外无任何当前诊断的6932名男性，其相对风险为1.14（95%可信区间，1.07 - 1.21）。与开放性前列腺切除术相比，没有证据表明TURP术后总体循环系统疾病、缺血性心脏病或急性心肌梗死的死亡风险增加。然而，呼吸系统疾病和癌症，尤其是前列腺癌和膀胱癌的死亡风险增加。分析表明开放性前列腺切除术可能治愈了一些早期前列腺癌患者，因为TURP术后前列腺癌的晚期死亡率高于开放性前列腺切除术。
本分析证实了与开放性前列腺切除术相比，TURP术后晚期死亡风险增加，正如先前基于行政记录的研究所显示的那样。然而，合并症编码的局限性以及患者病情更细微方面未进行编码，这些方面可能会影响前列腺切除术形式的选择，这意味着两种手术术后的死亡率差异仍可能反映患者的术前选择而非手术操作的影响。
