B超引导下经皮肾镜手术建立皮肾通道的学习曲线

Learning Curve in Percutaneous Nephrolithotomy under the Guidance of B Ultrasonography

目的探讨B超引导下经皮肾镜取石术中建立皮肾通道的学习曲线。方法回顾分析2006年1月～2007年7月由一名泌尿外科医生完成的B超引导下经皮肾镜取石术60例的临床资料,按手术时间先后顺序分为6组,每组10例,比较各组皮肾通道建立时间及清石率等指标的差异。结果第1组建立皮肾通道时间为(15.0±2.7)min,第2组为(14.0±2.1)min,第3组为(10.2±1.2)min,第4组为(5.8±0.7)min,第5组为(7.5±1.2)min,第6组为(6.6±0.9)min。方差分析组间皮肾通道建立时间有显著差异(F=5.77,P=0.000),2组间比较第1组与第4组(q=5.655,P<0.05)、第1组与第5组(q=4.610,P<0.05)、第1组与第6组(q=5.163,P<0.05)、第2组与第4组(q=5.040,P<0.05)、第2组与第5组(q=3.995,P<0.05)、第2组与第6组(q=4.549,P<0.05)皮肾通道建立时间有显著统计学差异,其余2组间比较均无显著统计学差异(P>0.05)。6组的清石率分别为70%、60%、70%、80%、90%及70%,各组比较无显著统计学差异(χ2=2.727,P=0.742)。结论学习经皮肾镜手术是个渐进的过程,完成30例手术后开始熟悉B超引导下建立皮肾通道,缩短建立皮肾通道的时间。

Objective To evaluate the learning curve in percutaneous nephrolithotomy under the guidance of B ultrasonography. Methods From January 2006 to July 2007, totally 60 cases of percutaneous nephrolithotomy were performed under the guidance of B ultrasonography by a single urologist. The patients were divided into 6 groups according to the date of the operation （10 cases in each）. The time for setting the renal access and the stone-free rate were compared among the groups. Results The time for setting the renal access was （ 15.0 ± 2.7） , （ 14.0 ± 2.1 ） , （ 10.2 ±1. 2 ） , （5.8± 0.7 ） , （ 7.5±1. 2 ） , and （ 6.6±0.9 ） minutes respectively in group 1 to 6. ANOVA analysis showed significant difference among the groups （ F = 5. 734, P = 0. 000）. Significant difference was detected between groups 1 and 4 （q = 5. 655, P〈0.05）, groups 1 and 5 （q=4.610,P〈0.05）, groups 1 and 6 （ q = 5. 163 ,P 〈 0.05 ） , groups 2 and 4 （ q = 5. 040 ,P 〈 0.05 ） , groups 2 and 5 （ q = 3. 995, P 〈 0.05 ） , and groups 2 and 6 （q =4. 549,P 〈 0.05）. The stone-free rate was 70%, 60%, 70%,80%, 90%, and 70% retrospectively in the groups 1 to 6 （X^2 = 2. 272,P = 0. 742）. Conclusions The skill of the surgeon improved gradually when learning PCNL. After finished 30 procedures, the time for setting the renal access can be reduced significantly.